Abstract
Extranodal NK/T cell lymphoma predominantly presents as a localized disease in the upper aerodigestive tract from the nasal cavity to the hypopharynx. Because radiotherapy has better outcomes than chemotherapy with reduced locoregional failure, it should be considered the preferred first-line therapy. However, the addition of chemotherapy is appropriate as part of the initial treatment because of the frequent systemic progression or relapse after radiotherapy. At present, the combination of radiotherapy and chemotherapy can be considered an effective treatment option, and the promising results of recent prospective studies with concurrent chemoradiotherapy support this treatment strategy. In contrast, intensive chemotherapy should be considered as initial treatment for patients with tumors in non-upper-aerodigestive-tract sites, such as skin or intestine because they usually progress to systemic disease. Likewise, for patients with poor prognostic factors, such as a high NK lymphoma prognostic index, autologous stem cell transplantation during remission and additional treatments with central nervous system prophylaxis may be beneficial. However, the precise role of these treatments needs to be clarified further by prospective clinical trials. Thus, a prospective study is warranted to explore a risk-adapted treatment strategy of applying initial chemoradiotherapy and additional consolidation treatments.
Similar content being viewed by others
References
Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, et al. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: report of the Clinical Advisory Committee meeting-Airlie House, Virginia, November 1997. J Clin Oncol. 1999;17:3835–49.
Jaffe ES, Chan JK, Su IJ, Frizzera G, Mori S, Feller AC, et al. Report of the workshop on nasal and related extranodal angiocentric T/natural killer cell lymphomas. Definitions, differential diagnosis, and epidemiology. Am J Surg Pathol. 1996;20:103–11.
Kanavaros P, Lescs MC, Briere J, Divine M, Galateau F, Joab I, et al. Nasal T-cell lymphoma: a clinicopathologic entity associated with peculiar phenotype and with Epstein–Barr virus. Blood. 1993;81:2688–95.
Au WY, Weisenburger DD, Intragumtornchai T, Nakamura S, Kim WS, Sng I, et al. Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: a study of 136 cases from the international peripheral T-cell lymphoma project. Blood. 2009;113:3931–7.
Oshimi K, Kawa K, Nakamura S, Suzuki R, Suzumiya J, Yamaguchi M, et al. NK-cell neoplasms in Japan. Hematology. 2005;10:237–45.
Kim WS, Song SY, Ahn YC, Ko YH, Baek CH, Kim DY, et al. CHOP followed by involved field radiation: is it optimal for localized nasal natural killer/T-cell lymphoma? Ann Oncol. 2001;12:349–52.
Kim BS, Kim TY, Kim CW, Kim JY, Heo DS, Bang YJ, et al. Therapeutic outcome of extranodal NK/T-cell lymphoma initially treated with chemotherapy—result of chemotherapy in NK/T-cell lymphoma. Acta Oncol. 2003;42:779–83.
Wang B, Lu JJ, Ma X, Guo Y, Lu H, Hong X, et al. Combined chemotherapy and external beam radiation for stage IE and IIE natural killer T-cell lymphoma of nasal cavity. Leuk Lymphoma. 2007;48:396–402.
Kim SJ, Kim BS, Choi CW, Seo HY, Seol HR, Sung HJ, et al. Treatment outcome of front-line systemic chemotherapy for localized extranodal NK/T cell lymphoma in nasal and upper aerodigestive tract. Leuk Lymphoma. 2006;47:1265–73.
Lee SH, Ahn YC, Kim WS, Ko YH, Kim K, Park K. The effect of pre-irradiation dose intense CHOP on anthracycline resistance in localized nasal NK/T-cell lymphoma. Haematologica. 2006;91:427–8.
Kim TM, Lee SY, Jeon YK, Ryoo BY, Cho GJ, Hong YS, et al. Clinical heterogeneity of extranodal NK/T-cell lymphoma, nasal type: a national survey of the Korean Cancer Study Group. Ann Oncol. 2008;19:1477–84.
Kim GE, Lee SW, Chang SK, Park HC, Pyo HR, Kim JH, et al. Combined chemotherapy and radiation versus radiation alone in the management of localized angiocentric lymphoma of the head and neck. Radiother Oncol. 2001;61:261–9.
Cheung MM, Chan JK, Lau WH, Ngan RK, Foo WW. Early stage nasal NK/T-cell lymphoma: clinical outcome, prognostic factors, and the effect of treatment modality. Int J Radiat Oncol Biol Phys. 2002;54:182–90.
You JY, Chi KH, Yang MH, Chen CC, Ho CH, Chau WK, et al. Radiation therapy versus chemotherapy as initial treatment for localized nasal natural killer (NK)/T-cell lymphoma: a single institute survey in Taiwan. Ann Oncol. 2004;15:618–25.
Kim K, Chie EK, Kim CW, Kim IH, Park CI. Treatment outcome of angiocentric T-cell and NK/T-cell lymphoma, nasal type: radiotherapy versus chemoradiotherapy. Jpn J Clin Oncol. 2005;35:1–5.
Li YX, Yao B, Jin J, Wang WH, Liu YP, Song YW, et al. Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol. 2006;24:181–9.
Huang MJ, Jiang Y, Liu WP, Li ZP, Li M, Zhou L, et al. Early or up-front radiotherapy improved survival of localized extranodal NK/T-cell lymphoma, nasal-type in the upper aerodigestive tract. Int J Radiat Oncol Biol Phys. 2008;70:166–74.
Suzuki R, Takeuchi K, Ohshima K, Nakamura S. Extranodal NK/T-cell lymphoma: diagnosis and treatment cues. Hematol Oncol. 2008;26:66–72.
Kohrt H, Advani R. Extranodal natural killer/T-cell lymphoma: current concepts in biology and treatment. Leuk Lymphoma. 2009;50:1773–84.
Liang R. Advances in the management and monitoring of extranodal NK/T-cell lymphoma, nasal type. Br J Haematol. 2009;147:13–21.
Kim TM, Heo DS. Extranodal NK/T-cell lymphoma, nasal type: new staging system and treatment strategies. Cancer Sci. 2009;100:2242–8.
Ribrag V, Ell Hajj M, Janot F, Girinsky T, Domenge C, Schwaab G, et al. Early locoregional high-dose radiotherapy is associated with long-term disease control in localized primary angiocentric lymphoma of the nose and nasopharynx. Leukemia. 2001;15:1123–6.
Yamaguchi M, Kita K, Miwa H, Nishii K, Oka K, Ohno T, et al. Frequent expression of P-glycoprotein/MDR1 by nasal T-cell lymphoma cells. Cancer. 1995;76:2351–6.
Chen JS, Lin KH, Lin DT, Chen RL, Jou ST, Su IJ. Longitudinal observation and outcome of nonfamilial childhood haemophagocytic syndrome receiving etoposide-containing regimens. Br J Haematol. 1998;103:756–62.
Uno M, Tsuchiyama J, Moriwaki A, Noguchi T, Mizoguchi K, Ogino T, et al. In vitro induction of apoptosis for nasal angiocentric natural killer cell lymphoma-derived cell line, NK-YS, by etoposide and cyclosporine A. Br J Haematol. 2001;113:1009–14.
Lee KW, Yun T, Kim DW, Im SA, Kim TY, Yoon SS, et al. First-line ifosfamide, methotrexate, etoposide and prednisolone chemotherapy ± radiotherapy is active in stage I/II extranodal NK/T-cell lymphoma. Leuk Lymphoma. 2006;47:1274–82.
Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, et al. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol. 2009;27:5594–600.
Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J, et al. Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed, stage IE to IIE, nasal, extranodal NK/T-cell lymphoma: Consortium for Improving Survival of Lymphoma Study. J Clin Oncol. 2009;27:6027–32.
Ando M, Sugimoto K, Kitoh T, Sasaki M, Mukai K, Ando J, et al. Selective apoptosis of natural killer-cell tumours by l-asparaginase. Br J Haematol. 2005;130:860–8.
Yong W, Zheng W, Zhu J, Zhang Y, Wang X, Xie Y, et al. l-Asparaginase in the treatment of refractory and relapsed extranodal NK/T-cell lymphoma, nasal type. Ann Hematol. 2008;88:647–52.
Jaccard A, Gachard N, Coppo P, Morschhauser F, Galicier L, Ysebaert L, et al. A prospective phase II trial of an l-asparaginase containing regimen in patients with refractory or relapsing extra nodal NKJT-cell lymphoma. Blood. 2008;112(11):217.
Koom WS, Chung EJ, Yang WI, Shim SJ, Suh CO, Roh JK, et al. Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints. Int J Radiat Oncol Biol Phys. 2004;59:1127–37.
Sakata K, Fuwa N, Kodaira T, Aratani K, Ikeda H, Takagi M, et al. Analyses of dose–response in radiotherapy for patients with mature T/NK-cell lymphomas according to the WHO classification. Radiother Oncol. 2006;79:179–84.
Lee J, Suh C, Park YH, Ko YH, Bang SM, Lee JH, et al. Extranodal natural killer T-cell lymphoma, nasal-type: a prognostic model from a retrospective multicenter study. J Clin Oncol. 2006;24:612–8.
Kim TM, Park YH, Lee SY, Kim JH, Kim DW, Im SA, et al. Local tumor invasiveness is more predictive of survival than International Prognostic Index in stage I(E)/II(E) extranodal NK/T-cell lymphoma, nasal type. Blood. 2005;106:3785–90.
Kim SJ, Kim BS, Choi CW, Choi J, Kim I, Lee YH, et al. Ki-67 expression is predictive of prognosis in patients with stage I/II extranodal NK/T-cell lymphoma, nasal type. Ann Oncol. 2007;18:1382–7.
Au WY, Pang A, Choy C, Chim CS, Kwong YL. Quantification of circulating Epstein–Barr virus (EBV) DNA in the diagnosis and monitoring of natural killer cell and EBV-positive lymphomas in immunocompetent patients. Blood. 2004;104:243–9.
Au WY, Lie AK, Liang R, Kwong YL, Yau CC, Cheung MM, et al. Autologous stem cell transplantation for nasal NK/T-cell lymphoma: a progress report on its value. Ann Oncol. 2003;14:1673–6.
Kim HJ, Bang SM, Lee J, Kwon HC, Suh C, Lee JH, et al. High-dose chemotherapy with autologous stem cell transplantation in extranodal NK/T-cell lymphoma: a retrospective comparison with non-transplantation cases. Bone Marrow Transplant. 2006;37:819–24.
Lee J, Au WY, Park MJ, Suzumiya J, Nakamura S, Kameoka J, et al. Autologous hematopoietic stem cell transplantation in extranodal natural killer/T cell lymphoma: a multinational, multicenter, matched controlled study. Biol Blood Marrow Transplant. 2008;14:1356–64.
Cheung MM, Chan JK, Lau WH, Foo W, Chan PT, Ng CS, et al. Primary non-Hodgkin’s lymphoma of the nose and nasopharynx: clinical features, tumor immunophenotype, and treatment outcome in 113 patients. J Clin Oncol. 1998;16:70–7.
Cuadra-Garcia I, Proulx GM, Wu CL, Wang CC, Pilch BZ, Harris NL, et al. Sinonasal lymphoma: a clinicopathologic analysis of 58 cases from the Massachusetts General Hospital. Am J Surg Pathol. 1999;23:1356–69.
Kim GE, Koom WS, Yang WI, Lee SW, Keum KC, Lee CG, et al. Clinical relevance of three subtypes of primary sinonasal lymphoma characterized by immunophenotypic analysis. Head Neck. 2004;26:584–93.
Kim SJ, Oh SY, Hong JY, Chang MH, Lee DH, Huh J, et al. When do we need central nervous system prophylaxis in patients with extranodal NK/T-cell lymphoma, nasal type? Ann Oncol 21:1058–63.
Chan JK, Sin VC, Wong KF, Ng CS, Tsang WY, Chan CH, et al. Nonnasal lymphoma expressing the natural killer cell marker CD56: a clinicopathologic study of 49 cases of an uncommon aggressive neoplasm. Blood. 1997;89:4501–13.
Lim ST, Hee SW, Quek R, Lim LC, Yap SP, Loong EL, et al. Comparative analysis of extra-nodal NK/T-cell lymphoma and peripheral T-cell lymphoma: significant differences in clinical characteristics and prognosis. Eur J Haematol. 2008;80:55–60.
Acknowledgment
This work was supported by the Samsung Medical Center Grant (CA98671).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kim, S.J., Kim, W.S. Treatment of localized extranodal NK/T cell lymphoma, nasal type. Int J Hematol 92, 690–696 (2010). https://doi.org/10.1007/s12185-010-0720-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12185-010-0720-8