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Clinical characteristics and treatment of NK/T-cell lymphoma–associated HLH

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Abstract

Natural killer (NK)/T-cell lymphoma–associated hemophagocytic lymphohistiocytosis (NK/T-LAHLH) is a rare and life-threatening disorder. Its clinical characteristics and appropriate treatment options are unclear. This study aimed to investigate the clinical characteristics and treatment options for this disease. We retrospectively analyzed the clinical data of 84 patients with NK/T-cell lymphoma and compared the characteristics, treatment, and survival between patients with and without HLH. Patients in the NK/T-LAHLH group were more likely to be younger age and have hepatosplenomegaly, B symptoms, neutropenia, anemia, thrombocytopenia, elevated lactate dehydrogenase levels, reduced serum albumin levels, bone marrow involvement, Ann Arbor stage III/IV, and International Prognostic Index score ≥ 3. After multivariate analysis, it was found that elevated lactate dehydrogenase and Ann Arbor stage III/IV were risk factors for HLH in patients with NK/T-cell lymphoma. After 2 weeks of therapy, 78.6% (11/14) patients who received the L-DEP/DEP regimen achieved an overall response rate of HLH, which was higher than that in 42.9% (9/21) patients who received the VP-16 + dexamethasone-based regimen. NK/T-LAHLH patients had poorer survival than non-HLH-NK/TCL patients. For NK/T-LAHLH, the L-DEP/DEP regimen may have a better response rate than the VP-16 + dexamethasone-based regimens.

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References

  1. Henter JI, Horne A, Aricó M, Egeler RM, Filipovich AH, Imashuku S, Ladisch S, McClain K, Webb D, Winiarski J, Janka G (2007) HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 48(2):124–131

    Article  Google Scholar 

  2. Skinner J, Yankey B, Shelton BK (2019) Hemophagocytic lymphohistiocytosis. AACN Adv. Crit Care 30(2):151–164

    Google Scholar 

  3. Rivière S, Galicier L, Coppo P, Marzac C, Aumont C, Lambotte O, Fardet L (2014) Reactive hemophagocytic syndrome in adults: a retrospective analysis of 162 patients. Am J Med 127(11):1118–1125

    Article  Google Scholar 

  4. Lehmberg K, Nichols KE, Henter JI, Girschikofsky M, Greenwood T, Jordan M, Kumar A, Minkov M, La Rosée P, Weitzman S, Study Group on HemophagocyticLymphohistiocytosis Subtypes of the Histiocyte Society (2015) Consensus recommendations for the diagnosis and management of hemophagocytic lymphohistiocytosis associated with malignancies. Haematologica 100(8):997–1004

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Fugl A, Andersen CL (2019) Epstein-Barr virus and its association with disease - a review of relevance to general practice. BMC Fam Pract 20(1):62

    Article  Google Scholar 

  6. Goudarzipour K, Kajiyazdi M, Mahdaviyani A (2013) Epstein-Barr virus-induced hemophagocytic lymphohistiocytosis. Int J Hematol Oncol Stem Cell Res 7(1):42–45

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Takahashi N, Miura I, Chubachi A, Miura AB, Nakamura S (2001) A clinicopathological study of 20 patients with T/natural killer (NK)-cell lymphoma-associated hemophagocytic syndrome with special reference to nasal and nasal-type NK/T-cell lymphoma. Int J Hematol 74(3):303–308

    Article  CAS  Google Scholar 

  8. Ishii E, Ohga S, Imashuku S, Yasukawa M, Tsuda H, Miura I, Yamamoto K, Horiuchi H, Takada K, Ohshima K, Nakamura S, Kinukawa N, Oshimi K, Kawa K (2007) Nationwide survey of hemophagocytic lymphohistiocytosis in Japan. Int J Hematol 86(1):58–65

    Article  Google Scholar 

  9. Cheson BD, Pfistner B, Juweid ME, Gascoyne RD, Specht L, Horning SJ, Coiffier B, Fisher RI, Hagenbeek A, Zucca E, Rosen ST, Stroobants S, Lister TA, Hoppe RT, Dreyling M, Tobinai K, Vose JM, Connors JM, Federico M, Diehl V (2007) International Harmonization Project on Lymphoma Revised response criteria for malignant lymphoma. J Clin Oncol 25(5):579–86

    Article  Google Scholar 

  10. Marsh RA, Allen CE, McClain KL, Weinstein JL, Kanter J, Skiles J, Lee ND, Khan SP, Lawrence J, Mo JQ, Bleesing JJ, Filipovich AH, Jordan MB (2013) Salvage therapy of refractory hemophagocytic lymphohistiocytosis with alemtuzumab. Pediatr Blood Cancer 60(1):101–9

    Article  CAS  Google Scholar 

  11. Jia J, Song Y, Lin N, Liu W, Ping L, Zheng W, Wang X, Xie Y, Tu M, Zhang C, Ying Z, Deng L, Ding N, Zhu J (2016) Clinical features and survival of extranodal natural killer/T cell lymphoma with and without hemophagocytic syndrome. Ann Hematol 95(12):2023–2031

    Article  CAS  Google Scholar 

  12. Li N, Zhang L, Liu J, Zhang J, Weng HW, Zhuo HY, Zou LQ (2017) A clinical study of 21 patients with hemophagocytic syndrome in 295 cases diagnosed with nasal type, extranodal nature killer/T cell lymphoma. Cancer Biol Ther 18(4):252–256. https://doi.org/10.1080/15384047.2017.1295176

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Liu YZ, Bi LQ, Chang GL, Guo Y, Sun S (2019) Clinical characteristics of extranodal NK/T-cell lymphoma-associated hemophagocytic lymphohistiocytosis. Cancer Manag Res 23(11):997–1002

    Article  Google Scholar 

  14. Han L, Zhang M, Li L, Zhang L, Wu J, Li X, Wang X, Young KH, Fu X, Ma W, Sun Z, Zhang X, Chang Y, Qiao Z (2014) Natural killer/T-cell lymphoma-associated hemophagocytic syndrome: a case report. Oncol Lett 8(2):886–890

    Article  Google Scholar 

  15. Wei L, Yang L, Cong J, Ye J, Li X, Yao N, Yang J, Ding J, Wang J (2020) Using etoposide + dexamethasone-based regimens to treat nasal type extranodal natural killer/T-cell lymphoma-associated hemophagocytic lymphohistiocytosis. J Cancer Res Clin Oncol 6:1–7

    Google Scholar 

  16. Han L, Li L, Wu J, Li X, Zhang L, Wang X, Fu X, Ma W, Sun Z, Zhang X, Chang Y, Guo S, Zhang M (2014) Clinical features and treatment of natural killer/T cell lymphoma associated with hemophagocytic syndrome: comparison with other T cell lymphoma associated with hemophagocytic syndrome. Leuk Lymphoma 55(9):2048–2055

    Article  CAS  Google Scholar 

  17. Li DH, Zhang XY, Du C, Zhang WH, Chang J, Ma YJ, Li ZC, Hao SG, Ding H, Tao R (2017) Successful treatment of extranodal natural killer/T-cell lymphoma-associated hemophagocytic lymphohistiocytosis with MEDA chemotherapy. Leuk Lymphoma 58(5):1238–1241

    Article  Google Scholar 

  18. Wang J, Wang Y, Wu L, Zhang J, Lai W, Wang Z (2016) PEG-aspargase and DEP regimen combination therapy for refractory Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis. J Hematol Oncol 9(1):84

    Article  Google Scholar 

  19. Ando M, Sugimoto K, Kitoh T, Sasaki M, Mukai K, Ando J, Egashira M, Schuster SM, Oshimi K (2005) Selective apoptosis of natural killer-cell tumours by l-asparaginase. Br J Haematol 130(6):860–868

    Article  CAS  Google Scholar 

  20. Yu JT, Wang CY, Yang Y, Wang RC, Chang KH, Hwang WL, Teng CL (2013) Lymphoma-associated hemophagocytic lymphohistiocytosis: experience in adults from a single institution. Ann Hematol 92(11):1529–1536

    Article  Google Scholar 

  21. Machaczka M, Nahi H, Karbach H, Klimkowska M, Hägglund H (2012) Successful treatment of recurrent malignancy-associated hemophagocytic lymphohistiocytosis with a modified HLH-94 immunochemotherapy and allogeneic stem cell transplantation. Med Oncol 29(2):1231–1236

    Article  CAS  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81871633).

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Correspondence to Zhao Wang.

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The work was approved by the Institutional Review Board of Friendship Hospital. The study has been performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

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Meng, G., Wang, J., Cui, T. et al. Clinical characteristics and treatment of NK/T-cell lymphoma–associated HLH. Ann Hematol 101, 2289–2296 (2022). https://doi.org/10.1007/s00277-022-04953-1

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