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Zhang X, Huang W, Qiu Y, Chen Z, Song L, Yang Q, Kang L. 18F-FDG PET/CT in extranodal natural killer/T-cell lymphoma: a comprehensive evaluation method. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2023; 13:245-258. [PMID: 38204603 PMCID: PMC10774604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
Extranodal NK/T-cell lymphoma (ENKTL) is an uncommon subtype of non-Hodgkin's lymphoma that is closely related to Epstein-Barr virus (EBV) infection. ENKTL exhibits distinctive clinicopathological features among lymphomas and has poor overall survival in the absence of effective treatment. The timely and accurate diagnosis of ENKTL is crucial for effective treatment and a positive prognosis. 18F-Fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) has emerged as an invaluable diagnostic modality for staging, curative effect evaluation, and prognosis analysis in ENKTL. We herein provide a comprehensive overview of the advances in the application of 18F-FDG PET/CT in patients with ENKTL.
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Affiliation(s)
- Xiaoyue Zhang
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Lele Song
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital Beijing 100034, PR China
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Wei YC, Qi F, Zheng BM, Zhang CG, Xie Y, Chen B, Liu WX, Liu WP, Fang H, Qi SN, Zhang D, Chai Y, Li YX, Wang WH, Song YQ, Zhu J, Dong M. Intensive therapy can improve long-term survival in newly diagnosed, advanced-stage extranodal NK/T-cell lymphoma: A multi-institutional, real-world study. Int J Cancer 2023; 153:1643-1657. [PMID: 37539660 DOI: 10.1002/ijc.34672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023]
Abstract
The study investigated the treatment and prognosis of advanced-stage extranodal natural killer/T-cell lymphoma (ENKTL). With a median follow-up of 75.03 months, the median overall survival (mOS) for the 195 newly diagnosed stage III/IV ENKTL patients was 19.43 months, and estimated 1-, 2-, 3- and 5-year OS were 59.5%, 46.3%, 41.8% and 35.1%, respectively. Chemotherapy (CT) + radiotherapy (RT) compared to CT alone (P = .007), and hematopoietic stem cell transplantation (HSCT) compared to non-HSCT (P < .001), both improved OS. For patients ≤60 years and ineligible for HSCT, other therapies with complete remission led to comparable OS (P = .141). Nine patients ever treated with chidamide achieved a median progression-free survival (mPFS) and mOS of 53.63 (range, 3.47-92.33) and 54.80 (range, 5.50-95.70) months, and four with chidamide maintenance therapy (MT) achieved a mPFS and mOS of 55.83 (range, 53.27-92.33) and 60.65 (range, 53.70-95.70) months, possibly providing an alternative option for non-HSCT patients. Non-anthracycline (ANT)- compared to ANT-, asparaginase (Aspa)- compared to non-Aspa- and gemcitabine (Gem)- compared to non-Gem-based regimens, prolonged PFS (P = .031; P = .005; P = .009) and OS (P = .010; P = .086; P = .003), respectively. Multivariate analysis demonstrated that Gem-based regimens improved PFS (HR = 0.691, P = .061) and OS (HR = 0.624, P = .037). Gem + Aspa combinations slightly improved PFS and OS compared to regimens containing Gem or Aspa alone (P > 0.05). First-line "intensive therapy," including CT (particularly Gem + Aspa regimens), RT, HSCT and alternative chidamide MT, was proposed and could improve long-term survival for advanced-stage ENKTLs. Ongoing prospective clinical studies may shed further light on the value of chidamide MT.
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Affiliation(s)
- Yu-Ce Wei
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Qi
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Bao-Min Zheng
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Chang-Gong Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Xie
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Xin Liu
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei-Ping Liu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Zhang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei-Hu Wang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yu-Qin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Zhu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Mei Dong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project. Sci Rep 2022; 12:20557. [PMID: 36446856 PMCID: PMC9709053 DOI: 10.1038/s41598-022-25034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study aims to report clinical characteristics, prognostic factors, and outcomes in a multicenter cohort of ENKTL patients from Brazil. This retrospective, observational and multicenter study included 98 ENKTL patients treated during two decades in Brazil. Data were extracted from the T-Cell Brazil Project database. In our cohort, 59/98 patients (60.2%) were male, with a median age of 50 years. Sixty-two patients (63.3%) had B-symptoms, 26/98 (26.5%) had Eastern Cooperative Oncology Group scale ≥ 2; 16/98 (16.3%) presented extranasal disease and 34.7% (34/98) were advanced-stage (Ann Arbor/Cotswolds III/IV). The median follow-up for the whole cohort was 49 months, with an estimated 2-year overall survival (OS) and progression-free survival (PFS) of 51.1% and 17.7%, respectively. In early-stage disease (IE/IIE), the median OS was 21.8 months for patients treated with concurrent radiotherapy plus chemotherapy (CCRT-VIPD [etoposide/vp-16, ifosfamide, cisplatin and dexamethasone), 16.2 months for sequential chemoradiotherapy (SCRT) followed by asparaginase-based regimens, and 56.7 months for SCRT followed by CHOP-like (cyclophosphamide, doxorrubicin, vincristine and prednisone) treatments, p = 0.211. CCRT was associated with higher rates of early-mortality, hematological toxicity, and mucositis. Median OS was 8.2 months for patients with advanced-stage disease receiving regimens containing asparaginase compared to 3.2 months for anthracycline-based therapy, p = 0.851. Chemo-radiotherapy (CRT) regimens demonstrated better OS (p = 0.001) and PFS (p = 0.007) than chemotherapy alone. Multivariate analysis revealed anemia, relapsed/refractory (R/R) disease and radiotherapy omission as poor outcome predictors for OS. Lymphopenia and radiotherapy omission adversely affected PFS. Concerning progression of disease within 24-months (POD-24), clinical stage III/IV was a poor outcome predictor. In this real-life Brazilian cohort, ENKTL presented dismal outcomes. Radiation therapy was an independent factor for increased OS and PFS, but CCRT regimens were associated with higher toxicities. Polychemotherapy based on anti-multi drug resistant agents was not associated with survival benefit in either early or advanced-stage disease in our patient cohort.
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Yang C, Wu W, Zhou H, Zhao S, Tian R, Xiang M, Zou L. 18F-FDG PET/CT Plays a Limited Role in Replacing Bone Marrow Biopsy for Newly Diagnosed Advanced-Stage Patients With Extranodal Natural Killer/T-Cell Lymphoma. Front Oncol 2022; 12:894804. [PMID: 35965550 PMCID: PMC9372794 DOI: 10.3389/fonc.2022.894804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose The role of 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in evaluating bone marrow (BM) involvement (BMI) among patients with extranodal natural killer/T-cell lymphoma (ENKTL) is poorly understood. This study investigated whether PET/CT could replace bone marrow biopsy (BMB) in treatment-naive ENKTL patients. Methods Newly diagnosed ENKTL patients (n = 356) who received BMB and PET/CT to evaluate BMI at the time of diagnosis were retrospectively reviewed at West China Hospital between August 2008 and January 2020. The BMI diagnosis was confirmed using BM histology. Clinical characteristics, survival outcomes, and prognostic indicators were summarized and analyzed. Results The cohort included 356 cases, of whom 261 were diagnosed with early-stage and 95 with advanced-stage ENKTL by PET/CT before initial treatment. No early-stage patients were identified with BMI by either BMB or PET/CT. Among the advanced-stage patients, 26 were BMB positive, and 12 of 22 patients (54.5%) with positive PET/BM results were also BMB positive. The sensitivity and specificity of PET/CT to detect BMI were 46% and 97%, respectively. The progression-free survival (PFS) and overall survival (OS) of PET/BM-negative patients were markedly longer (p = 0.010 and p = 0.001 for PFS and OS, respectively), which was consistent with the results of the BMB (p = 0.000 for both PFS and OS). Conclusion Although 18F-FDG PET/CT showed the potential to replace BMB in the initial staging of early-stage ENKTL patients, baseline PET/CT cannot provide an accurate BMI evaluation for advanced-stage patients. A prospective study is required to confirm the diagnostic performance of BMI identification by PET/CT, along with targeted BMB and MRI for advanced-stage patients.
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Affiliation(s)
- Chunli Yang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wanchun Wu
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Huijie Zhou
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
| | - Sha Zhao
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Maya Xiang
- Department of Chemistry, University of Washington-Seattle Campus, Seattle, WA, United States
| | - Liqun Zou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Oncology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Liqun Zou,
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Hue SSS, Ng SB, Wang S, Tan SY. Cellular Origins and Pathogenesis of Gastrointestinal NK- and T-Cell Lymphoproliferative Disorders. Cancers (Basel) 2022; 14:2483. [PMID: 35626087 PMCID: PMC9139583 DOI: 10.3390/cancers14102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
The intestinal immune system, which must ensure appropriate immune responses to both pathogens and commensal microflora, comprises innate lymphoid cells and various T-cell subsets, including intra-epithelial lymphocytes (IELs). An example of innate lymphoid cells is natural killer cells, which may be classified into tissue-resident, CD56bright NK-cells that serve a regulatory function and more mature, circulating CD56dim NK-cells with effector cytolytic properties. CD56bright NK-cells in the gastrointestinal tract give rise to indolent NK-cell enteropathy and lymphomatoid gastropathy, as well as the aggressive extranodal NK/T cell lymphoma, the latter following activation by EBV infection and neoplastic transformation. Conventional CD4+ TCRαβ+ and CD8αβ+ TCRαβ+ T-cells are located in the lamina propria and the intraepithelial compartment of intestinal mucosa as type 'a' IELs. They are the putative cells of origin for CD4+ and CD8+ indolent T-cell lymphoproliferative disorders of the gastrointestinal tract and intestinal T-cell lymphoma, NOS. In addition to such conventional T-cells, there are non-conventional T-cells in the intra-epithelial compartment that express CD8αα and innate lymphoid cells that lack TCRs. The central feature of type 'b' IELs is the expression of CD8αα homodimers, seen in monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), which primarily arises from both CD8αα+ TCRαβ+ and CD8αα+ TCRγδ+ IELs. EATL is the other epitheliotropic T-cell lymphoma in the GI tract, a subset of which arises from the expansion and reprograming of intracytoplasmic CD3+ innate lymphoid cells, driven by IL15 and mutations of the JAK-STAT pathway.
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Affiliation(s)
- Susan Swee-Shan Hue
- Department of Pathology, National University Hospital, Singapore 119074, Singapore; (S.S.-S.H.); (S.W.)
| | - Siok-Bian Ng
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
- Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Singapore
| | - Shi Wang
- Department of Pathology, National University Hospital, Singapore 119074, Singapore; (S.S.-S.H.); (S.W.)
| | - Soo-Yong Tan
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119074, Singapore;
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e300-e309. [PMID: 34848181 DOI: 10.1016/j.clml.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinical data from non-Asian countries are lacking. It is unclear whether outcomes and disease natural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosed CD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS One hundred and twenty-one patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treated with combined modality therapy (CMT) (n = 53), chemotherapy alone (CT) (n = 14) or radiotherapy alone (RT) (n = 16). Thirty-eight patients (31%) had stage III/IV disease and were treated with CMT (n = 12), CT (n = 23), or RT (n = 3). The median follow-up for the entire cohort was 51 months. Patients with stage I/II disease, compared to those with stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs 19% (P = .03) and overall survival (OS) 59% vs. 29% (P= .004). Outcomes were similar for stage I/II patients who received CMT vs. RT alone with 2-year PFS (53% vs. 47%; P= .91) and OS (67% vs. 67%; P= .58). No significant differences in outcomes were noted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. Our data are consistent with Asian studies: (1) majority of patients present with early-stage disease; (2) overall poor outcome regardless of race/ethnicity; (3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | - Jim Rose
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-Cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 22:e250-e260. [PMID: 34794912 DOI: 10.1016/j.clml.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinicaldata from non-Asian countries are lacking. It is unclear whether outcomes and diseasenatural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosedCD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS 121 patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treatedwith combined modality therapy (CMT) (n=53), chemotherapy alone (CT) (n=14) orradiotherapy alone (RT) (n=16). Thirty-eight patients (31%) had stage III/IV diseaseand were treated with CMT (n=12), CT (n=23), or RT (n=3). The median follow-up forthe entire cohort was 51 months. Patients with stage I/II disease, compared to thosewith stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs19% (p=0.03) and overall survival (OS) 59% vs 29% (p=0.004). Outcomes were similarfor stage I/II patients who received CMT vs RT alone with 2-year PFS (53% vs 47%;p=0.91) and OS (67% vs 67%; p=0.58). No significant differences in outcomes werenoted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. OUR DATA ARE CONSISTENT WITH ASIAN STUDIES 1) majority of patients present with early-stage disease; 2) overall poor outcome regardless of race/ethnicity; 3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Lauren S Maeda
- Division of Oncology, Stanford Cancer Institute, Stanford, CA
| | - Kerry J Savage
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Jim Rose
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Prediction and prevention of central nervous system relapse in patients with extranodal natural killer/T-cell lymphoma. Blood 2021; 136:2548-2556. [PMID: 32584959 DOI: 10.1182/blood.2020005026] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
Because non-anthracycline-based chemotherapy with l-asparaginase has improved survival outcomes in patients with extranodal natural killer/T-cell lymphoma (ENKTL), the incidence of central nerve system (CNS) relapse can be different when compared with that in previous reports. In this research, we sought to identify the incidence of and predictors for CNS relapse and to evaluate the necessity of CNS prophylaxis with intermediate-dose methotrexate (ID-MTX). The records of 399 patients in the training cohort and 253 patients in the validation cohort with ENKTL who received non-anthracycline-based chemotherapy were reviewed. Patients were divided into 2 groups according to whether the chemotherapy regimen included ID-MTX above 2 g/m2. A new central nervous system-prognostic index of natural killer (CNS-PINK) model was developed using 1-point powerful predictors of CNS relapse (PINK; hazard ratio [HR], 2.908; P = .030 and extranodal involvement [≥2]; HR, 4.161; P = .001) and was calculated as a sum of scores. The high-risk group of CNS-PINK was defined as 2 points. The cumulative incidence of CNS relapse was different between the CNS-PINK risk groups in the training (P < .001) and validation (P = .038) cohorts. Patients in the high-risk CNS-PINK group who were treated with SMILE or SMILE-like regimens with ID-MTX (S-ID-MTX) displayed a lower incidence rate of CNS relapse than did those who received other regimens without ID-MTX in the training cohort (P = .029). The CNS-PINK was demonstrated its strong predictability of CNS relapse in ENKTL patients. The effectiveness of S-ID-MTX in preventing CNS events in high-risk CNS-PINK patients should be verified in future studies.
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EBV and the Pathogenesis of NK/T Cell Lymphoma. Cancers (Basel) 2021; 13:cancers13061414. [PMID: 33808787 PMCID: PMC8003370 DOI: 10.3390/cancers13061414] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
Epstein-Barr virus (EBV) is a ubiquitous gamma herpes virus with tropism for B cells. EBV is linked to the pathogenesis of B cell, T cell and NK cell lymphoproliferations, with extranodal NK/T cell lymphoma, nasal type (ENKTCL) being the prototype of an EBV-driven lymphoma. ENKTCL is an aggressive neoplasm, particularly widespread in East Asia and the native population of Latin America, which suggests a strong genetic predisposition. The link between ENKTCL and different populations has been partially explored. EBV genome sequencing analysis recognized two types of strains and identified variants of the latent membrane protein 1 (LMP1), which revealed different oncogenic potential. In general, most ENKTCL patients carry EBV type A with LMP1 wild type, although the LMP1 variant with a 30 base pair deletion is also common, especially in the EBV type B, where it is necessary for oncogenic transformation. Contemporary high-throughput mutational analyses have discovered recurrent gene mutations leading to activation of the JAK-STAT pathway, and mutations in other genes such as BCOR, DDX3X and TP53. The genomic landscape in ENKTCL highlights mechanisms of lymphomagenesis, such as immune response evasion, secondary to alterations in signaling pathways or epigenetics that directly or indirectly interfere with oncogenes or tumor suppressor genes. This overview discusses the most important findings of EBV pathogenesis and genetics in ENKTCL.
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Xia X, Wang Y, Yuan J, Sun W, Jiang J, Liu C, Zhang Q, Ma X. Baseline SUVmax of 18F-FDG PET-CT indicates prognosis of extranodal natural killer/T-cell lymphoma. Medicine (Baltimore) 2020; 99:e22143. [PMID: 32925768 PMCID: PMC7489640 DOI: 10.1097/md.0000000000022143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
To evaluate the prognostic value of the baseline SUVmax of F-FDG PET-CT in extranodal natural killer/T-cell lymphoma (NKTCL) patients.From January 2010 to December 2015, 141 extranodal NKTCL patients with staging F-FDG PET-CT scan were divided into two group based on SUVmax cutoff value obtained from operating characteristic (ROC) curves. All the patients received radiotherapy, chemotherapy or chemoradiation. Survival analysis was performed on the basis of SUVmax.The median baseline SUVmax of the tumors was 11.67 (range 2.6-34.6). The ROC curves showed that the optimal cutoff of the baseline SUVmax was 9.65. The patients were divided into two groups: low SUV group (SUVmax < 9.65) and high SUV group (SUVmax ≥ 9.65). Patients in high SUV group were more likely to have invasive disease outside the nasal cavity (P < .001), poorer ECOG scores (P = .012) and higher LDH levels (P = .034). The univariate survival analyses indicated that high SUVmax was a poor prognostic factor for overall survival (OS, P = .038), progression free survival (PFS, P = .006) and distant relapse free survival (DRFS, P = .001), but not for local recurrence free survival (LRFS, P > .05). These results were consistent with that of the survival analyses using the Kaplan-Meier method. The multivariate survival analyses showed that the baseline SUVmax was no longer a prognostic factor for OS (HR 1.99, 95% CI 0.81-4.88, P = .135), but it still indicated worse PFS (HR 2.6, 95% CI 1.24-5.46, P = .012) and DRFS (HR 4.58, 95% CI 1.83-11.46, P = .001) independent of other variables.For extranodal NKTCL patients, a higher baseline SUVmax of F-FDG PET-CT was associated with more aggressive clinical features. An SUVmax ≥ 9.65 was an independent poor prognostic factor for DRFS and PFS. Thus, the baseline SUVmax may be a valuable tool to help identify patients with a high risk of disease progression.
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Affiliation(s)
- Xianwu Xia
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, Zhejiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jianjun Yuan
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, Zhejiang
| | - Wenjie Sun
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
| | - Jinjin Jiang
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
| | - Chang Liu
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
| | - Qunling Zhang
- Department of Oncology, Shanghai Medical College, Fudan University
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, PR China
| | - Xuejun Ma
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center
- Department of Oncology, Shanghai Medical College, Fudan University
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12
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Peterson E, Weed J, Lo Sicco K, Latkowski JA. Cutaneous T Cell Lymphoma: A Difficult Diagnosis Demystified. Dermatol Clin 2020; 37:455-469. [PMID: 31466586 DOI: 10.1016/j.det.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous T cell lymphoma (CTCL) represents a heterogeneous group of extranodal non-Hodgkin lymphomas in which monoclonal T lymphocytes infiltrate the skin. The mechanism of CTCL development is not fully understood, but likely involves dysregulation of various genes and signaling pathways. A variety of treatment modalities are available, and although they can induce remission in most patients, the disease may recur after treatment cessation. Owing to relatively low incidence and significant chronicity of disease, and the high morbidity of some therapeutic regimens, further clinical trials are warranted to better define the ideal treatment option for each subtype of CTCL.
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Affiliation(s)
- Erik Peterson
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jason Weed
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA
| | - Jo-Ann Latkowski
- The Ronald O. Perelman Department of Dermatology, 240 East 38th Street, 11th Floor, New York, New York 10016, USA; New York Harbor VA Healthcare System, Dermatology Residency Training Program.
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13
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Liu J, Liang L, Li D, Nong L, Zheng Y, Huang S, Zhang B, Li T. JAK3/STAT3 oncogenic pathway and PRDM1 expression stratify clinicopathologic features of extranodal NK/T‑cell lymphoma, nasal type. Oncol Rep 2019; 41:3219-3232. [PMID: 31002364 PMCID: PMC6488994 DOI: 10.3892/or.2019.7112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
The inactivation of tumor suppressor gene positive regulatory domain containing I (PRDM1) and activation of signal transducer and activator of transcription 3 (STAT3) have been detected in the majority of extranodal NK/T‑cell lymphoma, nasal type (EN‑NK/T‑NT) cases. In the present study, their association with and effects on the clinicopathologic features of EN‑NK/T‑NT are described. PRDM1 was revealed to be expressed in 19 out of 58 patients (32.8%) with EN‑NK/T‑NT, and phosphorylated STAT3 was overexpressed in 42 out of 58 (72.4%). Oncogenic pathways were investigated by NanoString encounter technology in 5 PRDM1(+) and 5 PRDM1(‑) EN‑NK/T‑NT specimens. Multiple oncogenic pathways involved in cell apoptosis, cellcycle (CC) and angiogenesis were discriminately activated in EN‑NK/T‑NT cases, and in PRDM1(+) cases in particular. The sustained activation of the Janus kinase 3 (JAK)/STAT3 pathway was more pronounced. In addition, missense mutations in the SRC homology 2 domain of STAT3 were detected in 7 out of 37 EN‑NK/T‑NT cases (18.92%), and the acquired mutation was related to the activation of the JAK3/STAT3 pathway. The downregulation of PRDM1 and upregulation of phospho‑STAT3 (Tyr705) were associated with angiocentric infiltration of EN‑NK/T‑NT (P=0.039). Notably, the prognosis of patients in the PRDM1(+)/STAT3 [mutated (mut‑)] group was considerably improved than that of patients in the STAT3(mut+)/PRDM(‑) group (P=0.037). In addition, the inhibition of NK/T cell lymphoma cell lines by Stattic and tofacitinib could suppress cell proliferation by inducing cell apoptosis or arresting the CC. The present results revealed that the JAK3/STAT3 oncogenic pathway and PRDM1 expression could stratify clinicopathologic features of EN‑NK/T‑NT. The inhibition of the JAK3/STAT3 pathway may serve as a treatment option for EN‑NK/T‑NT.
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Affiliation(s)
- Jumei Liu
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Li Liang
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Dong Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Yalin Zheng
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Sixia Huang
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Bo Zhang
- Department of Pathology, Peking University Health Science Center, Beijing 100191, P.R. China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing 100034, P.R. China
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Zhang L, Li S, Jia S, Nan F, Li Z, Cao J, Fan S, Zhang C, Su L, Wang J, Xue H, Zhang M. The DDGP (cisplatin, dexamethasone, gemcitabine, and pegaspargase) regimen for treatment of extranodal natural killer (NK)/T-cell lymphoma, nasal type. Oncotarget 2018; 7:58396-58404. [PMID: 27517317 PMCID: PMC5295438 DOI: 10.18632/oncotarget.11135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 07/09/2016] [Indexed: 12/01/2022] Open
Abstract
Extranodal natural killer/T cell lymphoma (ENKL) is a high invasive disease with poor prognosis. Since there is no consensus on standard chemotherapy, we developed an original chemotherapeutic DDGP (cisplatin, dexamethasone, gemcitabine, and pegaspargase) regimen. We retrospectively analyzed 80 patients who received DDGP chemotherapy. The primary end point was progression-free survival (PFS) and secondary end points were overall survival (OS), complete response rate (CRR), and overall response rate (ORR). The one-year PFS and OS rates were 86.0% and 88.6%, and the 2-year PFS and OS rates were 81.40% and 87.1%, respectively. The ORR and CRR of DDGP chemotherapy were 91.3% and 60.0%. The major adverse events were myelosuppression, digestive tract toxicities, and coagulation disorder. No treatment-related deaths were observed. Our results suggest that the DDGP regimen is a high effective and safe treatment for ENKL.
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Affiliation(s)
- Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Sucai Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Sisi Jia
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jingyu Cao
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Shanshan Fan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Chao Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Liping Su
- Department of Hematology, Shanxi Cancer Hospital, Taiyuan, Shanxi, China
| | - Jinghua Wang
- Department of Oncology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China
| | - Hongwei Xue
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
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Efficacy of combined gemcitabine, oxaliplatin and pegaspargase (P-gemox regimen) in patients with newly diagnosed advanced-stage or relapsed/refractory extranodal NK/T-cell lymphoma. Oncotarget 2018; 7:29092-101. [PMID: 27093153 PMCID: PMC5045380 DOI: 10.18632/oncotarget.8647] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive neoplasm with a poor outcome. Asparaginase-based regimens are recommended for patients with advanced-stage or relapsed/refractory ENKTL. We retrospectively investigated the efficacy and toxicity of combined gemcitabine, oxaliplatin, and pegaspargase (P-gemox) in these patients. A total of 35 patients with newly diagnosed stage III–IV, relapsed or refractory ENKTL were treated with 2 to 8 cycles of P-gemox: gemcitabine (1250 mg/m2) and oxaliplatin (85 mg/m2) injected intravenously and pegaspargase (2500 IU/m2) injected intramuscularly on day 1 and repeated every 2 weeks. Upon completion of treatment, the overall response rate was 80.0%, with a complete response in 51.4% of patients. The 1-, 2- and 3- year progression-free survival rates were 45.0%, 38.6% and 38.6%, and overall survival rates were 76.8%, 64.7% and 64.7%, respectively. Patients who attained a complete response showed better progression-free survival than those without a complete response (p = 0.01). The major adverse effects were hematologic toxicity and liver dysfunction. Grade 3/4 leucopenia and neutropenia occurred in 40.0% of patients. No treatment-related deaths occurred. These results indicate the P-gemox regimen is a safe and effective treatment for patients with newly diagnosed advanced-stage or relapsed/refractory ENKTL. We anticipate future prospective trials will confirm the efficacy.
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Song M, Kim JY, Choi JS, Yoon B, Kim M, Kim SJ, Kim SY. Primary Pulmonary Extranodal Natural Killer/T-cell Lymphoma, Nasal Type Presenting as Diffuse Ground Glass Opacities: a Case Report. J Korean Med Sci 2017; 32:1727-1730. [PMID: 28875622 PMCID: PMC5592192 DOI: 10.3346/jkms.2017.32.10.1727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/13/2016] [Indexed: 11/20/2022] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL) is a rare type of lymphoma that accounts for only 5%-18% of all cases of non-Hodgkin lymphoma (NHL). In published series, 60%-90% of NK/T-cell lymphomas are localized to the nasal and upper airway. We describe a 55-year man who presented with cough, sputum, dyspnea on exertion, and a chest computed tomography scan shows diffuse ground glass opacities (GGOs), suggestive of an interstitial lung disease. He was treated with a corticosteroid and his symptoms improved. However, when the corticosteroid was tapered, his symptoms recurred. The patient underwent a surgical lung biopsy and ENKTCL was diagnosed. We present this case because ENKTCL involving only the lung is very rare but very informative. To our knowledge, our patient is the first case that primary pulmonary ENKTCL is presented with GGOs.
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Affiliation(s)
- MyungJin Song
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Bora Yoon
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - MooHyun Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Jeong Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.
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Wu CC, Takahashi E, Asano N, Miyata-Takata T, Takata K, Furukawa K, Elsayed AA, Hu LM, Satou A, Kohno K, Kosugi H, Ohashi K, Kinoshita T, Nakamura S, Kato S. Primary cutaneous NK/T-cell lymphoma of nasal type: an age-related lymphoproliferative disease? Hum Pathol 2017; 68:61-68. [PMID: 28873353 DOI: 10.1016/j.humpath.2017.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/10/2017] [Accepted: 08/23/2017] [Indexed: 11/29/2022]
Abstract
Among extranodal NK/T-cell lymphoma of nasal type (NKTL), the extranasal variant (ENKTL) is known to have a worse prognosis with advanced clinical stage than the nasal variant of NKTL. However, detailed clinicopathological features of the localized extranasal disease have not been well documented in English literature. Here, we described the clinicopathological profiles of 14 patients with stage I ENKTL, including 7 in the skin, 5 in the gastrointestinal tract, and 2 in the central nervous system, highlighting the distinctiveness of the first. The 7 primary cutaneous (PCNKTL) cases were characterized by an older onset age (median, 76 versus 53 years, P=.012) and a more favorable clinical course (P=.041) compared with 17 patients with stages II-IV ENKTL that showed cutaneous involvement. The skin lesions in the PCNKTL group were distributed in the face or neck (n=4) and limbs (n=3) but not the trunk, which was most frequently affected (60%, P=.017) in the latter group. Furthermore, the stage I cutaneous disease showed a female predominance (male-female, 2:5 versus 7:0; P=.021) and a significantly more favorable survival compared with the noncutaneous stage I ENKTL (P=.037). These results suggest that PCNKTL constitute a distinct subgroup in the nasal-type lymphoma spectrum.
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Affiliation(s)
- Chun-Chieh Wu
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 807; Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560
| | - Emiko Takahashi
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan 480-1195
| | - Naoko Asano
- Department of Molecular Diagnostics, Nagano Prefectural Suzaka Hospital, Suzaka, Japan 382-0091
| | - Tomoko Miyata-Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan 700-8558
| | - Katsuyoshi Takata
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan 700-8558; Centre for Lymphoid Cancer, BC Cancer Agency, Department of Pathology, British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3 Canada
| | - Katsuya Furukawa
- Department of Hematology, Ogaki Municipal Hospital, Ogaki, Japan 503-8502
| | - Ahmed Ali Elsayed
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560; Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt 35516
| | - Lei-Ming Hu
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560; Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan 466-8560
| | - Akira Satou
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560; Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan 480-1195
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560
| | - Hiroshi Kosugi
- Department of Hematology, Ogaki Municipal Hospital, Ogaki, Japan 503-8502
| | - Kenichi Ohashi
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan 236-0016
| | - Tomohiro Kinoshita
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan 464-8681
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560
| | - Seiichi Kato
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan 466-8560; Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan 464-8681.
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Vargo JA, Patel A, Glaser SM, Balasubramani GK, Farah RJ, Marks SM, Beriwal S. The impact of the omission or inadequate dosing of radiotherapy in extranodal natural killer T-cell lymphoma, nasal type, in the United States. Cancer 2017; 123:3176-3185. [DOI: 10.1002/cncr.30697] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/30/2017] [Accepted: 02/18/2017] [Indexed: 02/02/2023]
Affiliation(s)
- John A. Vargo
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Arisha Patel
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Scott M. Glaser
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Goundappa K. Balasubramani
- Epidemiology Data Center; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health; Pittsburgh Pennsylvania
| | - Rafic J. Farah
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Stanley M. Marks
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
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Dacryoadenitis as the Initial Presentation of a Natural Killer T-Cell Lymphoma. Ophthalmic Plast Reconstr Surg 2017; 33:e147-e150. [PMID: 28328558 DOI: 10.1097/iop.0000000000000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary orbital natural killer T-cell lymphoma (NKTCL) is a rare condition with only a few published cases in the literature. Over 1 month, an 81-year-old man developed progressive left periocular inflammation unresponsive to treatment. Clinical examination and imaging studies demonstrated a left lacrimal gland enlargement. Bilateral anterior uveitis and erythematous nontender cutaneous lesions were also found. Biopsies of the skin and lacrimal gland on the back revealed histopathologic and immunohistochemical findings confirming Epstein-Barr virus-positive NKTCL. Metastatic work up disclosed multifocal involvement in the pancreas, stomach, and chest wall. Palliative treatment consisting of nonanthracycline-based chemotherapy and radiation was instituted, but the patient died 5 months after the onset of symptoms. This is the first example of acute dacryoadenitis, and the second of bilateral anterior uveitis, in the setting of NKTCL. Absence of naso-sinus involvement in the current case is rare in NKTCL. Despite treatment, the prognosis remains dismal. Orbital specialists should include NKTCL in the differential diagnosis of lacrimal gland/orbital masses and perform an incisional biopsy if the clinical scenario so dictates.
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Zuhaimy H, Aziz HA, Vasudevan S, Hui Hui S. Extranodal natural killer/T-cell lymphoma presenting as orbital cellulitis. GMS OPHTHALMOLOGY CASES 2017; 7:Doc04. [PMID: 28194321 PMCID: PMC5296617 DOI: 10.3205/oc000055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To report an aggressive case of extranodal natural killer/T-cell lymphoma (NKTCL) of the ethmoid sinus presenting as orbital cellulitis Method: Case report Results: A 56-year-old male presented with right eye redness, reduced vision, and periorbital swelling for 5 weeks duration associated with a two-month history of blocked nose. The visual acuity of the right eye was 6/18. The eye was proptosed with periorbital oedema and conjunctival chemosis. The pupil was mid-dilated but there was no relative afferent pupillary defect. The fundus was normal. The extraocular movements were restricted in all directions of gaze. Nasal endoscopy revealed pansinusitis that corresponded with CT scan orbit and paranasal sinuses findings. Despite treatment, he showed no clinical improvement. Ethmoidal sinus biopsies performed revealed extranodal NKTCL. Further imaging showed involvement of the right orbital contents and its adnexa with intracranial extension into the right cavernous sinus and meninges over right temporal fossa. The patient underwent chemotherapy. However he succumbed to his illness two months after the diagnosis. Conclusion: Extranodal NKTCL is a great mimicker. This case demonstrated how an acute initial presentation of extranodal NKTCL can present as orbital cellulitis with pansinusitis.
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Affiliation(s)
- Hanis Zuhaimy
- Ophthalmology Department, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
| | - Hayati Abdul Aziz
- Ophthalmology Department, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
| | - Suresh Vasudevan
- Ophthalmology Department, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
| | - Siah Hui Hui
- Pathology Department, Hospital Sultanah Aminah Johor Bahru, Johor, Malaysia
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Intratumoral Heterogeneity of Pretreatment 18F-FDG PET Images Predict Disease Progression in Patients With Nasal Type Extranodal Natural Killer/T-cell Lymphoma. Clin Nucl Med 2017; 41:922-926. [PMID: 27749404 DOI: 10.1097/rlu.0000000000001375] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate whether the textural features of pretreatment F-FDG PET images can predict prognosis for nasal type extranodal natural killer/T-cell lymphoma (ENKTL). MATERIALS AND METHODS A retrospective analysis of the pretreatment F-FDG PET images of the patients with newly diagnosed nasal type ENKTL from 2008 to 2013 was conducted. Progression-free survival (PFS) was the main outcome measure. The primary tumor was identified and then delineated using the 40% maximum standardized uptake value (SUVmax) thresholding method. The textural features of the pretreatment F-FDG PET images were extracted. The prognostic significance of the textural features of the PET images were examined using the receiver operating characteristic (ROC) curves and Cox regression analysis. P values <0.05 were considered statistically significant. RESULTS In total, 17 patients were enrolled, among whom 11 showed disease progression and 6 died from the disease during the median follow-up period of 27.2 months. Dissimilarity and low-intensity short-zone emphasis (LISZE) were identified as independent predictors of PFS by using the ROC curves and multivariate Cox analysis after adjusting for the clinical variables. CONCLUSIONS Dissimilarity and LISZE were the significant predictors of disease progression in patients with nasal type ENKTL and can improve their prognostic stratification.
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Abstract
Natural killer T-cell lymphoma (NKTCL) is a rare and aggressive condition with a high mortality rate. It is most commonly seen in the nasal sinuses, generally affecting the orbit by direct extension. Primary orbital NKTCL is even more rare, with only a few published cases with occasional secondary nasal involvement. This malignancy can present as a "masquerade syndrome," delaying proper diagnosis and treatment. Biopsy is required for diagnosis, which shows specific histopathological characteristics. Radiation and chemotherapy are the mainstay of treatment. Newer chemotherapies show improved prognosis.
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Affiliation(s)
- Juan C Jiménez-Pérez
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Michael K Yoon
- a Ophthalmic Plastic and Reconstructive Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
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Park KG, Dhong ES, Namgoong S, Han JK, Han SK, Kim WK. Recurrent Extranodal NK/T-Cell Lymphoma Presenting as a Perforating Palatal Ulcer and Oro-Nasal Fistula. Arch Craniofac Surg 2016; 17:165-168. [PMID: 28913276 PMCID: PMC5556807 DOI: 10.7181/acfs.2016.17.3.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/20/2016] [Accepted: 07/01/2016] [Indexed: 11/11/2022] Open
Abstract
Nasal-type extranodal natural killer/T-cell lymphoma (ENKTL) is a rare disease presenting with non-specific symptoms, typically originating in the nasal cavity, palate, or midfacial region. Oral cavity is an extremely rare site for this type of lymphoma. In this report, we present a case of palatal perforation and oro-nasal fistula as a manifestation of recurrent ENKTL. Complicated disease entity should be considered when surgeons deal with palatal perforation and oro-nasal fistula.
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Affiliation(s)
- Kang Gyun Park
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Sang Dhong
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sik Namgoong
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Kyu Han
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Kyu Han
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Genetic alterations of JAK/STAT cascade and histone modification in extranodal NK/T-cell lymphoma nasal type. Oncotarget 2016; 6:17764-76. [PMID: 25980440 PMCID: PMC4627344 DOI: 10.18632/oncotarget.3776] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/13/2015] [Indexed: 01/05/2023] Open
Abstract
Extranodal NK/T-cell lymphoma nasal type (ENKL) is a rare type of non-Hodgkin lymphoma that more frequently occurs in East Asia and Latin America. Even though its molecular background has been discussed in the last few years, the current knowledge does not explain the disease pathogenesis in most cases of ENKL. Here, we performed multiple types of next-generation sequencing on 34 ENKL samples, including whole-exome sequencing (9 cancer tissues and 4 cancer cell lines), targeted sequencing (21 cancer tissues), and RNA sequencing (3 cancer tissues and 4 cancer cell lines). Mutations were found most frequently in 3 genes, STAT3, BCOR, and MLL2 (which were present in 9, 7, and 6 cancer samples, respectively), whereas there were only 2 cases of JAK3 mutation. In total, JAK/STAT pathway- and histone modification-related genes accounted for 55.9% and 38.2% of cancer samples, respectively, and their involvement in ENKL pathogenesis was also supported by gene expression analysis. In addition, we provided 177 genes upregulated only in cancer tissues, which appear to be linked with angiocentric and angiodestructive growth of ENKL. In this study, we propose several novel driver genes of ENKL, and show that these genes and their functional groups may be future therapeutic targets of this disease.
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Bu S, Yuan F, Wei X, Yin Q, Li Y, Mi R, Yang H, Li H, Ge S, Liu Y, Song Y. L-asparaginase-based regimen as a first-line treatment for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma. Exp Ther Med 2016; 11:2437-2445. [PMID: 27313673 DOI: 10.3892/etm.2016.3249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/15/2015] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to compare the efficacy of an L-asparaginase-based regimen and a CHOP regimen followed by radiotherapy as first-line treatments for newly diagnosed nasal type extranodal natural killer cell/T-cell lymphoma (ENKTL). A total of 69 patients received the CHOP regimen as the first-line treatment and 112 patients received the L-asparaginase-based regimen. All patients received radical radiotherapy following two cycles of chemotherapy. The overall response rates of the L-asparaginase-based and CHOP treatment groups were 90.18 and 72.46%, respectively (P=0.002). The one, two, and five-year overall survival (OS) rates and progression-free survival (PFS) rates of the L-asparaginase group were 96.0, 88.3, 65.1, 94.2, 79.8 and 50.0%, respectively. The one, two, and five-year OS and PFS rates of the CHOP group were 82.6, 61.9, 25.8, 63.8, 44.0 and 21.0%, respectively (P<0.001). Compared with CHOP treatment, L-asparaginase-based chemotherapy combined with radiotherapy was a safe and highly effective treatment for newly diagnosed ENKTL.
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Affiliation(s)
- Shanshan Bu
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Fangfang Yuan
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Xudong Wei
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Qingsong Yin
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Yufu Li
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Ruihua Mi
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Haiping Yang
- Department of Hematology, First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P.R. China
| | - Hongyi Li
- Department of Hematology, Xinzheng People's Hospital, Xinxiang, Henan 453000, P.R. China
| | - Shoubei Ge
- Department of Hematology, Second Jiaozuo People's Hospital, Jiaozuo, Henan 522000, P.R. China
| | - Yanyan Liu
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
| | - Yongping Song
- Department of Hematology, Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China
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Expression and significance of Ku80 and PDGFR-α in nasal NK/T-cell lymphoma. Pathol Res Pract 2016; 212:204-9. [DOI: 10.1016/j.prp.2015.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022]
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Extra-nodal natural killer/T cell lymphoma in elderly patients: the impact of aging on clinical outcomes and treatment tolerability. Ann Hematol 2016; 95:581-91. [DOI: 10.1007/s00277-015-2581-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/16/2015] [Indexed: 11/27/2022]
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Zhang X, Zhao L, Li X, Wang X, Li L, Fu X, Sun Z, Li Z, Nan F, Chang Y, Zhang M. ATP-binding cassette sub-family C member 4 (ABCC4) is overexpressed in human NK/T-cell lymphoma and regulates chemotherapy sensitivity: Potential as a functional therapeutic target. Leuk Res 2015; 39:1448-54. [PMID: 26499190 DOI: 10.1016/j.leukres.2015.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 08/11/2015] [Accepted: 10/04/2015] [Indexed: 02/07/2023]
Abstract
Nasal-type natural killer/T-cell (NK/T-cell) lymphomas are subtypes of non-Hodgkin's lymphoma (NHL), which are typically more clinically aggressive. There is, however relatively little understanding of nasal-type NK/T-cell lymphoma molecular pathogenesis. Thus, in this study we applied RNA sequencing to systematically screen for altered gene expression in human NK/T-cell lymphoma cell lines YTS and SNK-6 versus normal NK cells. We found that ATP-binding cassette sub-family C Member 4 (ABCC4) levels were significantly upregulated both in human NK/T-cell lymphoma YTS and SNK-6 cells, as compared with normal NK cells. These expression levels were further confirmed by real-time PCR. Protein levels of ABCC4 were also significantly higher in YTS and SNK-6 cells as compared with normal NK cells. Clinically relevant, ABCC4 expression levels were significantly higher in human NK/T-cell lymphoma tissues as compared with control nasal mucosa tissues, confirmed by immunohistochemical staining. In addition, we explored the biological function of such ABCC4 upregulation. Overexpression of ABCC4 by lentivirus transfection induced chemotherapy resistance to epirubicin (EPI) and cisplatin (DDP) in YTS cells. In contrast, knockdown of ABCC4 expression by shRNA contributed to chemotherapy sensitivity by both EPI and DDP. Furthermore, overexpression of ABCC4 inhibited, while downregulation of ABCC4 increased, YTS cell apoptosis following treatment by EPI or DDP. Therefore, the present study identified ABCC4 to be overexpressed in human NK/T-cell lymphoma cells, to regulate chemotherapy sensitivity to EPI and DDP, and possibly to be a functional therapeutic target. These findings may provide a basic rationale for new approaches in the effort to develop anti-tumor therapeutics for NK/T-cell lymphoma.
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Affiliation(s)
- Xudong Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Lu Zhao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Ling Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China
| | - Mingzhi Zhang
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1 Jian She Road, Zhengzhou, Henan, China.
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Oh D, Ahn YC, Kim SJ, Kim WS, Ko YH. Concurrent Chemoradiation Therapy Followed by Consolidation Chemotherapy for Localized Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type. Int J Radiat Oncol Biol Phys 2015; 93:677-83. [PMID: 26461010 DOI: 10.1016/j.ijrobp.2015.07.2267] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the effectiveness of concurrent chemoradiation therapy (CCRT) with 40 Gy followed by consolidation chemotherapy for localized extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type. METHODS AND MATERIALS From August 2004 to August 2012, 62 patients with newly diagnosed stage IE to IIE ENKTL underwent CCRT followed by consolidation chemotherapy. The median RT dose was 40 Gy. Cisplatin, 30 mg/m(2), was administered weekly during the RT course. Responders to CCRT were encouraged to undergo consolidation chemotherapy. Three different consolidation chemotherapy regimens were used consecutively: VIPD (etoposide, ifosfamide, cisplatin, and dexamethasone); VIDL (etoposide, ifosfamide, and dexamethasone followed by intramuscular injection of l-asparaginase); and MIDLE (methotrexate, etoposide, ifosfamide, mesna, and l-asparaginase). RESULTS The median follow-up period was 49 months (range 8-112). After completion of CCRT, 56 patients (90.3%) had a complete response, 4 (6.4%) had a partial response, 1 (1.6%) had stable disease, and 1 patient (1.6%) had progressive disease (PD). Consolidation chemotherapy was recommended to 61 patients, after excluding the patient with PD, but was actually delivered to 58. Of these 58 patients, 56 (96.5%) had a complete response and 2 (3.5%) had PD. During the follow-up period, 17 patients (including 3 with PD) experienced progression. The median interval to progression was 11 months (range 1-61). Local failure developed in 6 patients, of whom, 2 had developed progression outside the RT field. For all patients, the 3-year overall survival, progression-free survival, and local control rates were 83.1%, 77.1%, and 92.4%, respectively. Grade ≥3 nonhematologic toxicity developed in only 3 patients (4.8%). CONCLUSIONS Excellent clinical outcomes were achieved using CCRT with 40 Gy followed by consolidation chemotherapy. Additional investigation, however, is warranted to confirm our findings.
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Affiliation(s)
- Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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High numbers of CD68+ tumor-associated macrophages correlate with poor prognosis in extranodal NK/T-cell lymphoma, nasal type. Ann Hematol 2015; 94:1535-44. [PMID: 25990795 DOI: 10.1007/s00277-015-2401-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
Many studies have demonstrated that tumor-associated macrophages (TAMs) were a prognostic indicator in patients with B cell lymphoma. But, we know little about the clinical significance of TAMs in extranodal natural killer/T cell lymphoma(ENKTL), nasal type. CD68 expression was detected using immunohistochemistry to determine the numbers of TAMs in 70 ENKTL patients, and the data were used to evaluate its relationship with clinicopathological features, treatment response, and prognosis. Patients with high number of infiltrated CD68+ TAMs (>60/hpf) at diagnosis tended to have more adverse clinical characteristics. Patients with low CD68+ TAM content (<60/hpf) at diagnosis had better overall survival (P = 0.003) and progression-free survival (P = 0.002) and achieved higher complete remission rates (P = 0.008). Multivariate analysis revealed that CD68 + TAM content, Ki-67 index, and stage III and IV were independent prognostic factors for both OS and PFS. Using the International Prognostic Index or Korean Prognostic Index for extranodal NK/T cell lymphoma, nasal type, the majority of patients were in the low-risk category. CD68 + TAM content was helpful to differentiate the low-risk patients with different survival outcomes. Our data suggest that CD68+ TAM content at diagnosis is a powerful predictor of prognosis for ENKTL, which suggests a role for TAMs in the pathogenesis of this disease and offers new insight into potential therapeutic strategies.
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31
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Wang YQ, Yang Y, Zhuo HY, Zou LQ, Jiang Y, Jiang M. Trial of LVDP regimen (L-asparaginase, etoposide, dexamethasone, and cisplatin, followed by radiotherapy) as first-line treatment for newly diagnosed, stage III/IV extranodal natural killer/T cell lymphoma. Med Oncol 2015; 32:435. [PMID: 25572807 DOI: 10.1007/s12032-014-0435-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 02/05/2023]
Abstract
Stage III/IV extranodal natural killer/T cell lymphoma (ENKL) has a poor response and poor survival. Given the sensitivity of ENKL to radiotherapy and the fact that there is no consensus on standard chemotherapy, we conducted a clinical trial of LVDP regimen, combining LVDP chemotherapy (containing etoposide, dexamethasone, L-asparaginase, and cisplatin), followed by radiotherapy as a consolidation therapy regimen, for newly diagnosed patients with stage III/IV ENKL to evaluate the efficacy and safety of this regimen. The primary endpoints were overall response rate (ORR) and survival [overall survival (OS) and progression-free survival (PFS)] at 1 or 2 years, while the secondary endpoints were toxicity and adverse effects. In total, 18 patients were enrolled in this trial from July 2010 to September 2013. The mean completed cycles of chemotherapy was 4.04 (range 1-8 cycles), and the ORR was 50 %. During a mean follow-up of 21.8 months (range 2-51 months), the 1-year OS and PFS rates were 72.2 and 50.0 %, respectively, the 2-year OS and PFS rates were 33.3 and 22.2 %, respectively, and the median OS and PFS were 23.0 and 10.5 months, respectively. Severe adverse effects during therapy included six cases of grade 3/4 bone marrow suppression and one case of grade 3 transaminase increase. Sex, eastern cancer oncology group, performance status, Korean Prognostic Index, International Prognostic index, and bone marrow infiltration may influence the prognosis of advanced-stage ENKL.
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Affiliation(s)
- Y Q Wang
- Center of Medical Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
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Li P, Jiang L, Zhang X, Liu J, Wang H. CD30 expression is a novel prognostic indicator in extranodal natural killer/T-cell lymphoma, nasal type. BMC Cancer 2014; 14:890. [PMID: 25429803 PMCID: PMC4258942 DOI: 10.1186/1471-2407-14-890] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 11/20/2014] [Indexed: 11/21/2022] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), is an aggressive type of lymphoma whose standard treatment and validated prognostic model have not yet been defined. Methods CD30 expression was detected using immunohistochemistry in 96 ENKTL patients, and the data were used to evaluate its relationship with clinical features, treatment response and prognosis. Results Expression of CD30 was detected in 31.2% of ENKTL patients, which was significantly correlated with B symptoms and elevated serum lactate dehydrogenase. The complete remission rate was not significantly different between CD30-positive and negative groups. After a median follow-up time of 31 months, 5-year overall survival (OS) and 5-year progression-free survival (PFS) rates in the CD30-positive group were both significantly lower than those in the CD30-negative group (34.1% vs. 64.4%, P = 0.002, for 5 year-OS; 26.0% vs. 66.7%, P < 0.001, for 5 year-PFS). In patients with an International Prognostic Index (IPI) or Korean Prognostic Index (KPI) score of 0–1, CD30 positivity was associated with shorter 5-year OS and PFS (IPI: P = 0.001 and 0.002, respectively; KPI: P = 0.018 and 0.023, respectively). In a multivariate Cox regression model, CD30 expression and stage were independent prognostic factors for OS (p = 0.004 and p = 0.012, respectively) and PFS (p = 0.001 and p = 0.022, respectively). Conclusions Our results showed that expression of CD30 was not related to response to treatment but was an independent prognostic factor for both OS and PFS in ENKTL, nasal type, which suggests a role for CD30 in the pathogenesis of this disease and may support the incorporation of anti-CD30-targeted therapy into the treatment paradigm for ENKTL.
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Affiliation(s)
| | | | | | | | - Hua Wang
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou 510060, China.
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Moncada B, Sobrevilla-Ondarza S, Md JDM. Radiotherapy supports a better outcome than chemotherapy in cutaneous natural killer (NK)/T cell lymphoma nasal type. Int J Dermatol 2014; 52:1276-7. [PMID: 24073909 DOI: 10.1111/j.1365-4632.2011.05196.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Moncada
- Department of Dermatology and Hospital Central "Dr Ignacio Morones Prieto" Universidad Autónoma de San Luis Potosí (Independent University of San Luis Potosi) San Luis PotosiMexicoDepartment of Otolaryngology Hospital Central "Dr Ignacio Morones Prieto" Universidad Autónoma de San Luis Potosí (Independent University of San Luis Potosi) San Luis PotosiMexico E-mail:
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Termote K, Dierickx D, Verhoef G, Jorissen M, Tousseyn T, Mombaerts I. Series of extranodal natural killer/T-cell lymphoma, nasal type, with periorbital involvement. Orbit 2014; 33:245-51. [PMID: 24831171 DOI: 10.3109/01676830.2014.902478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To describe the clinical presentation, diagnosis and treatment of periorbital extranodal natural killer/T-cell lymphoma, nasal type. METHODS Case series of three patients with periorbital involvement of extranodal natural killer/T-cell lymphoma, nasal type, of whom clinical data, orbital imaging and immunohistochemical analysis were collected. For the purpose of this study, all histopathological and immunohistochemical slides were re-examined. RESULTS All patients presented with painless eyelid swelling and a history of sinonasal disease, of whom one with bilateral panuveitis, not responding to systemic antibiotics. Extraocular muscle involvement was present in 2 cases upon presentation and in 1 case later on. Initial paranasal and orbital biopsies were negative in 2 patients, with only the second orbital biopsy leading to the diagnosis. Natural killer/T-cell and cytotoxic markers were present in all cases, as well as Epstein-Barr virus encoded RNA in situ hybridization. The patients died respectively 5, 9 and 35 months from diagnosis despite treatment with chemotherapy and radiotherapy. CONCLUSION Extranodal natural killer/T-cell lymphoma, nasal type, should be suspected in a painless periorbital cellulitis with chronic sinusitis, not responding to conventional therapy. A high index of suspicion is necessary in biopsies showing angiodestruction and necrosis. Epstein-Barr virus encoded RNA in situ hybridization and expert hematopathologist consultation is necessary to decrease the delay in diagnosis.
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Manso R, Rodríguez-Pinilla SM, Lombardia L, Ruiz de Garibay G, del Mar López M, Requena L, Sánchez L, Sánchez-Beato M, Piris MÁ. An A91V SNP in the perforin gene is frequently found in NK/T-cell lymphomas. PLoS One 2014; 9:e91521. [PMID: 24632576 PMCID: PMC3954696 DOI: 10.1371/journal.pone.0091521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/12/2014] [Indexed: 12/24/2022] Open
Abstract
NK/T-cell lymphoma (NKTCL) is the most frequent EBV-related NK/T-cell disease. Its clinical manifestations overlap with those of familial haemophagocytic lymphohistiocytosis (FHLH). Since PERFORIN (PRF1) mutations are present in FHLH, we analysed its role in a series of 12 nasal and 12 extranasal-NKTCLs. 12.5% of the tumours and 25% of the nasal-origin cases had the well-known g.272C>T(p.Ala91Val) pathogenic SNP, which confers a poor prognosis. Two of these cases had a double-CD4/CD8-positive immunophenotype, although no correlation was found with perforin protein expression. p53 was overexpressed in 20% of the tumoral samples, 80% of which were of extranasal origin, while none showed PRF1 SNVs. These results suggest that nasal and extranasal NKTCLs have different biological backgrounds, although this requires validation.
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Affiliation(s)
- Rebeca Manso
- Pathology Department, Fundación Jiménez Díaz, Madrid, Spain
| | - Socorro María Rodríguez-Pinilla
- Pathology Department, Fundación Jiménez Díaz, Madrid, Spain
- Molecular Pathology Programme, Lymphoma Group, CNIO, Madrid, Spain
- * E-mail:
| | - Luis Lombardia
- Clinical Research Programme, Molecular Diagnostics Clinical Research Unit, CNIO, Madrid, Spain
| | - Gorka Ruiz de Garibay
- Molecular Pathology Programme, Lymphoma Group, CNIO, Madrid, Spain
- Clinical Immunology Department, Hospital Clínico de San Carlos, Madrid, Spain
| | - Maria del Mar López
- Molecular Pathology Programme, Lymphoma Group, CNIO, Madrid, Spain
- Biotechnology Programme, Monoclonal Antibodies Unit, CNIO, Madrid, Spain
| | - Luis Requena
- Dermatology Department, Fundación Jimenez Díaz, Madrid, Spain
| | - Lydia Sánchez
- Biotechnology Programme, Immunohistochemistry Unit, CNIO, Madrid, Spain
| | - Margarita Sánchez-Beato
- Molecular Pathology Programme, Lymphoma Group, CNIO, Madrid, Spain
- Oncology-Haematology Area, Instituto Investigación Sanitaria, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Miguel Ángel Piris
- Molecular Pathology Programme, Lymphoma Group, CNIO, Madrid, Spain
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IFIMAV, Santander, Spain
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Prognostic impact of beta-2 microglobulin in patients with extranodal natural killer/T cell lymphoma. Ann Hematol 2014; 93:995-1000. [PMID: 24441948 DOI: 10.1007/s00277-014-2015-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Although serum beta-2 microglobulin (B2M) has been suggested as an independent prognostic factor for several lymphoproliferative diseases, it has rarely been investigated in extranodal natural killer/T cell lymphoma (ENKTL). From a prospectively collected database, 145 patients with ENKTL were identified. Among them, a total of 101 patients were included in the analysis, with exclusion of patients without baseline serum B2M level and those did not receive anticancer therapy. Serum B2M (<3.0 vs. ≥3.0 mg/L) was analyzed for association with overall survival (OS). Seventy-nine (78 %) patients had nasal ENKTL, and 22 (22 %) had extranasal ENKTL. In overall patients, median OS was 26.7 months (95 % confidence interval (CI), not assessable), with a median follow-up of 32.4 months (range, 0.9-155.2 months). While median OS was not reached in patients with nasal ENKTL, extranasal ENKTL group had median OS of 5.1 months (95 % CI, 1.2-8.9 months; p < 0.001). Baseline serum B2M was significantly associated with OS in patients with nasal ENKTL (p < 0.001). This was consistent in limited (stages I and II) nasal ENKTL (p = 0.002) and disseminated (stages III and IV) nasal ENKTL (p = 0.02). However, there was no difference of OS in extranasal ENKTL patients (p = 0.69). In multivariate analysis including other prognostic factors, elevated serum B2M was significantly associated with poor OS (hazard ratio (HR) = 3.8, 95 % CI 1.7-8.2, p = 0.001, in a model including Korean Prognostic Index, and HR = 3.6, 95 % CI 1.6-8.2, p = 0.002, in a model including International Prognostic Index). In patients with nasal ENKTL, baseline serum B2M is a powerful prognostic factor. The prognostic value of B2M was independent of previously established prognostic models. Further investigations are necessary to validate the role of B2M in ENKTL.
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Jiang L, Li SJ, Jiang YM, Long JX, Wang RS, Su J, Zhang Y. The significance of combining radiotherapy with chemotherapy for early stage extranodal natural killer/T-cell lymphoma, nasal type: a systematic review and meta-analysis. Leuk Lymphoma 2013; 55:1038-48. [PMID: 23885795 DOI: 10.3109/10428194.2013.827789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Radiotherapy is regarded as a primary treatment for early stage extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL). However, whether combined modality treatment (CMT) comprising radiotherapy and chemotherapy is necessary remains controversial. A systematic review and meta-analysis of studies was performed to evaluate the significance of combining radiotherapy with chemotherapy for early stage ENKTL. Comparison of CMT and radiotherapy alone (RT) showed no significant difference by the measurement of complete response (CR) (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.73-1.58; p = 0.73), 5-year overall survival rate (OS) (HR 0.73; 95% CI 0.45-1.19; p = 0.21) and progression-free survival rate (PFS) (HR 0.76; 95% CI 0.50-1.17; p = 0.21). Additional chemotherapy did not decrease systemic failure (OR 1.52; 95% CI 0.97-2.40; p = 0.07), as well as locoregional failure (OR 0.94; 95% CI 0.52-1.73; p = 0.85). The results may support the assertion that the combination of radiotherapy with chemotherapy cannot improve treatment outcomes, but rather it increases adverse effects and financial costs. However, these results should be interpreted with caution.
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Affiliation(s)
- Li Jiang
- Department of Radiotherapy, The First Affiliated Hospital, Guangxi Medical University , Nanning , China
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Abstract
Natural killer (NK)/T-cell lymphomas and NK-cell leukemias are aggressive malignancies. Occurring worldwide, they show a predilection for Asian and South American populations. Neoplastic cells are surface CD3-, cytoplasmic CD3ε+, CD56+, cytotoxic-molecule positive, Epstein-Barr virus (EBV) positive, with germline T-cell receptor gene. Lymphomas occur commonly in the nasal and upper aerodigestive region. Occasional cases present in the skin, salivary gland, testis, and gastrointestinal tract. Rare cases are disseminated with lymphadenopathy, hepatosplenomegaly, and a leukemic phase. Positron emission tomography computed tomography is useful in staging, as lymphomas are 18-fluorodeoxyglucose avid. Quantification of circulating EBV DNA is an accurate biomarker of tumor load. Nasal NK/T-cell lymphomas present mostly with stage I/II disease. Concomitant/sequential chemotherapy and radiotherapy is standard treatment. Radiotherapy alone is inadequate because of high systemic failure rate. For stage III/IV nasal, nonnasal, and disseminated lymphomas, systemic chemotherapy is indicated. Regimens containing l-asparaginase and drugs unaffected by P-glycoprotein are most effective. Hematopoietic stem cell transplantation (HSCT) is not indicated for early-stage nasal lymphomas. HSCT for lymphomas not in remission has poor results. In advanced-stage nasal, nonnasal, disseminated, or relapsed lymphomas, HSCT may be considered when remission is achieved. Prognostic modeling and EBV DNA monitoring may be useful in risk stratification for HSCT.
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Predictive value of pretreatment positron emission tomography/computed tomography in patients with newly diagnosed extranodal natural killer/T-cell lymphoma. Med Oncol 2013; 30:339. [PMID: 23329306 DOI: 10.1007/s12032-012-0339-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
Abstract
The role of (18)Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in extranodal natural killer/T-cell lymphoma (ENKL) is not well established. This study aimed to investigate the prognostic role of the pretreatment maximum standardized uptake value (SUV(max)) on PET/CT in patients with newly diagnosed ENKL. Among 364 consecutive patients with newly diagnosed ENKL, 81 patients were included and reviewed. The impact of SUV(max) on survival and the relationship between SUV(max) and other clinicopathological parameters were analyzed. The median SUV(max) was 14.6 (range 2.0-45.4). The optimal cutoff value of SUV(max) to predict overall survival (OS) was 15. Patients with high SUV(max) (SUVmax >15) were associated with bulky disease (P < 0.001), local invasion (P = 0.030), high score of Korean Prognostic Index (KPI, P = 0.046), resistance to primary treatment (P = 0.014), poor OS (P < 0.001), and unfavorable progression-free survival (P < 0.001). With a median follow-up of 25.0 months, the median OS was 63.0 months (range 2.0-99.0 months). Multivariate analyses revealed the following independent prognostic factors for OS: age >60 years (P = 0.001), stage III-IV (P = 0.023), SUV(max) >15 (P = 0.020), and bulky disease (>5 cm) (P = 0.002). By using the SUV(max), patients in most subgroups stratified by the KPI or the International Prognostic Index (IPI) were further discriminated in OS with significant statistical difference. Our results suggest the pretreatment SUV(max) is predictive of prognosis in patients with newly diagnosed ENKL. The SUV(max) may provide additional prognostic information for IPI and KPI.
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Tlholoe MM, Kotu M, Khammissa RAG, Bida M, Lemmer J, Feller L. Extranodal natural killer/T-cell lymphoma, nasal type: 'midline lethal granuloma.' A case report. Head Face Med 2013; 9:4. [PMID: 23327615 PMCID: PMC3564726 DOI: 10.1186/1746-160x-9-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/11/2013] [Indexed: 11/10/2022] Open
Abstract
Extranodal natural killer/T cell lymphoma, nasal type, is a non-Hodgkin lymphoma, most commonly affecting the nasal cavity, paranasal sinuses and nasopharynx. Clinically it is characterised by destruction of facial tissues, commencing in the midline. In most cases it arises from malignant transformation of natural killer cells (NK); sometimes from malignant transformation of cytotoxic T cells.Extranodal NK/T cell lymphoma, nasal type, is rare, but even more rare in black persons. The purpose of this article is to report a severe case of extranodal NK/T cell lymphoma, nasal type, in an elderly black male.
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Affiliation(s)
- Martha M Tlholoe
- Department of Maxillofacial and Oral Surgery, University of Limpopo, Medunsa Campus, South Africa
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Lee J, Cho SG, Chung SM, Ryu MR, Kim SH, Jang HS, Choi BO. Retrospective analysis of treatment outcomes for extranodal NK/T-cell lymphoma (ENKL), nasal type, stage I-IIE: single institute experience of combined modality treatment for early localized nasal extranodal NK/T-cell lymphoma (ENKL). Ann Hematol 2012. [PMID: 23180438 DOI: 10.1007/s00277-012-1630-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is a very aggressive disease frequently involving the nasal cavity and upper aerodigestive tract. We retrospectively reviewed the treatment outcomes and treatment-associated complications of the patients with stage I-II early localized ENKL. A total of 24 patients were included. All patients were treated with combined chemoradiotherapy. Three, sixteen, and five patients were initially treated with radiation therapy, chemotherapy, and surgical procedures, respectively. Nine patients underwent hematopoietic stem cell transplantation (HSCT), and four patients administered immunotherapy with pegylated-interferon alpha. The mean observation time was 71.6 months (range, 29.7-183.6 months). Twenty patients achieved complete remission; thus, the overall response rate was 83.3 %. The 5-year overall survival (OS) and relapse-free survival (RFS) rates were 70.3 % and 62.2 %, respectively. In univariate analysis, HSCT was a significant prognostic indicator for OS and RFS. By combining HSCT, the 5-year OS and RFS rates were 100.0 % vs. 52.5 % (p = 0.018) and 88.9 % vs. 45.7 % (p = 0.045), respectively. Also, absence of B symptoms was a good prognostic factor for RFS, the 5-year RFS rate, 75.0 % vs. 25.0 % (p = 0.010), and B symptoms were significant for RFS in multivariate analysis (odds ratio = 7.4, confidence interval = 1.6~34.1, p = 0.011). However, a total of four cases of grade 3 toxicities were reported. Radiation dose range (≤4,500 vs. >4,500 cGy) was significantly correlated with late complications, as more severe complications occurred more frequently with a radiation dose >4,500 cGy (p = 0.026, in multivariate analysis). For more efficient treatment of ENKL, chemotherapy, HSCT, and/or immunotherapy can be combined with radiation therapy to prolong long-term survival and achieve good local control. Also, lower radiation dose could be administered to avoid severe late complications.
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Affiliation(s)
- Jayoung Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic Medical Center, College of Medicine, The Catholic University of Korea, 137-701, Banpo-dong, 505, Seocho-gu, Seoul, South Korea
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Ahn HK, Kim SJ, Hwang DW, Ko YH, Tang T, Lim ST, Kim WS. Gemcitabine alone and/or containing chemotherapy is efficient in refractory or relapsed NK/T-cell lymphoma. Invest New Drugs 2012; 31:469-72. [DOI: 10.1007/s10637-012-9889-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/08/2012] [Indexed: 11/29/2022]
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Chauchet A, Michallet AS, Berger F, Bedgedjian I, Deconinck E, Sebban C, Antal D, Orfeuvre H, Corront B, Petrella T, Hacini M, Bouteloup M, Salles G, Coiffier B. Complete remission after first-line radio-chemotherapy as predictor of survival in extranodal NK/T cell lymphoma. J Hematol Oncol 2012; 5:27. [PMID: 22682004 PMCID: PMC3416641 DOI: 10.1186/1756-8722-5-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 06/08/2012] [Indexed: 01/06/2023] Open
Abstract
Background Extranodal nasal-type NK/T-cell lymphoma is a rare and severe disease. Considering the rarity of this lymphoma in Europe, we conducted a multicentric retrospective study on nasal-type NK/T cell lymphoma to determine the optimal induction strategy and identify prognostic factors. Methods Thirty-six adult patients with nasal-type NK/T-cell lymphoma were recruited and assessed. In total, 80 % of patients were classified as having upper aerodigestive tract NK/T-cell lymphoma (UNKTL) and 20 % extra-upper aerodigestive tract NK/T-cell lymphoma (EUNKTL). Results For advanced-stage disease, chemotherapy alone (CT) was the primary treatment (84 % vs. 10 % for combined CT + radiation therapy (RT), respectively), while for early-stage disease, 50 % of patients received the combination of CT + RT and 50 % CT alone. Five-year overall survival (OS) and progression-free survival (PFS) rates were 39 % and 33 %. Complete remission (CR) rates were significantly higher when using CT + RT (90 %) versus CT alone (33 %) (p < 0.0001). For early-stage disease, CR rates were 37 % for CT alone versus 100 % for CT + RT. Quality of response was significantly associated with survival, with 5-year OS being 80 % for CR patients versus 0 % for progressive disease patients (p < 0.01). Conclusion Early RT concomitantly or sequentially with CT led to improved patient outcomes, with quality of initial response being the most important prognosticator for 5-year OS.
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Affiliation(s)
- Adrien Chauchet
- Department of Hematology, Centre Hospitalier universitaire Lyon Sud, Pierre Benite, France
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Serum beta2-microglobin is a predictor of prognosis in patients with upper aerodigestive tract NK/T-cell lymphoma. Ann Hematol 2012; 91:1265-70. [PMID: 22373550 DOI: 10.1007/s00277-012-1434-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
Upper aerodigestive tract natural killer (NK)/T-cell lymphoma (UNKTL) is the most common type of extranodal NK/T-cell lymphoma, nasal type. Serum beta2-microglobulin (β2-M) was found to be a predictor in some subtypes of B-cell lymphoma. However, its prognostic significance in NK/T-cell lymphoma has never been explored. We retrospectively analyzed 82 patients newly diagnosed as UNKTL. Serum β2-M was detected prior to treatment in this series. Various statistical analyses were performed to evaluate the significance of the relevant clinical parameters. High serum β2-M level was calculated as ≥2.5 mg/L by the median value. The number of patients with serum β2-M ≥2.5 mg/L at diagnosis was 39 (47.6%) and 43 patients (52.4%) with β2-M <2.5 mg/L. Patients with high serum β2-M level at diagnosis seemed to have more adverse clinical features: B symptoms (p=0.007) and elevated LDH level (p<0.001), and high KPI score (p=0.002). Serum β2-M ≥2.5 mg/L was significantly associated with poor overall survival (5-year OS, 35.2% vs 73.6%; p=0.001) and progression-free survival (5-year PFS, 27.5% vs 55.9%; p=0.028). For patients with early stage, serum β2-M at diagnosis could also help to distinguish those with favorable outcomes from those with poor outcomes. In multivariate analysis, high serum β2-M level remained its prognostic impact on survival (OS: p=0.002; PFS: p=0.039), independent of the International Prognostic Index score. Our study suggested high serum β2-M was a novel predictor of prognosis in patients with UNKTL. A simply and regular way might be established to identify UNKTL patients of different risks at diagnosis.
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Qi SN, Li YX, Wang WH, Jin J, Wang SL, Liu YP, Song YW, Fang H, Ren H, Lu NN, Liu QF, Wu RY, Zhang XM, Liu XF, Yu ZH. The extent of cutaneous lesions predicts outcome in extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract with secondary cutaneous involvement. Leuk Lymphoma 2011; 53:855-61. [PMID: 22035375 DOI: 10.3109/10428194.2011.634040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study determined the clinical characteristics and prognosis for patients with extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) with secondary cutaneous involvement. Twenty-eight patients with NKTCL of the upper aerodigestive tract with secondary cutaneous involvement were reviewed. The median overall survival (OS) was 21.5 months from the first diagnosis, and 12.3 months from the presentation of a cutaneous lesion. The 5-year OS rate was 43.1% (median, 28 months) for patients with localized cutaneous disease compared with 0% (median, 3.6 months) for generalized cutaneous disease (p = 0.017). The 2-year OS rates were 67.5% for patients who achieved a complete response (CR) compared with 19.4% (median, 5.2 months) for patients who did not (p = 0.003). Patients with NKTCL with secondary cutaneous dissemination overall have a poor prognosis, but a relatively favorable prognosis was identified for the small subgroup of patients who had localized cutaneous lesions and achieved a CR.
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Affiliation(s)
- Shu-Nan Qi
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Beijing , People's Republic of China
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Kang SM, Kim WJ, Lee KA, Baek HS, Park TS, Jin HY. Mainly adrenal gland involving NK/T-cell nasal type lymphoma diagnosed with delay due to mimicking adrenal hemorrhage. J Korean Med Sci 2011; 26:1386-90. [PMID: 22022195 PMCID: PMC3192354 DOI: 10.3346/jkms.2011.26.10.1386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 03/22/2011] [Indexed: 12/29/2022] Open
Abstract
A 29-yr-old man, presented with abdominal pain and fever, had an initial computed tomography (CT) scan revealing low attenuation of both adrenal glands. The initial concern was for tuberculous adrenalitis or autoimmune adrenalitis combined with adrenal hemorrhage. The patient started empirical anti-tuberculous medication, but there was no improvement. Enlargement of cervical lymph nodes were developed after that and excisional biopsy of cervical lymph nodes was performed. Pathological finding of excised lymph nodes was compatible to NK/T-cell lymphoma. The patient died due to the progression of the disease even after undergoing therapeutic trials including chemotherapy. Lymphoma mainly involving adrenal gland in the early stage of the disease is rare and the vast majority of cases that have been reported were of B-cell origin. From this case it is suggested that extra-nodal NK/T-cell lymphoma should be considered as a cause of bilateral adrenal masses although it is rare.
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Affiliation(s)
- Seon Mee Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woong Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Hong Sun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
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Kohrt H, Lee M, Advani R. Risk stratification in extranodal natural killer/T-cell lymphoma. Expert Rev Anticancer Ther 2011; 10:1395-405. [PMID: 20836675 DOI: 10.1586/era.10.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL), a subtype of natural killer/T-cell malignancies, is a rare subset of lymphomas with significant biological and clinical heterogeneity. The prognosis of ENKL is variable and therapeutic approaches are not well established. The optimal dose, combination, and sequence of radiotherapy and chemotherapy are evolving, as is the role of stem cell transplantation. Radiotherapy is an essential component of therapy for early-stage disease. The clinical course of advanced disease is highly aggressive, with frequent chemotherapy resistance and a poor prognosis. For relapsed disease, asparaginase-based regimens have provided encouraging results and are currently under investigation in the frontline setting. Our article discusses the key aspects of biology, pathogenesis and clinical presentation that contribute to the heterogeneity, and proposes a stratified approach to the treatment of ENKL based on clinical, pathologic and biologic risk factors. Although considerable advances have been made in our understanding of the biology and prognosis of this lymphoma, it remains critical that all patients with a diagnosis of ENKL are enrolled and treated in clinical trials so that optimal therapies can be identified.
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Affiliation(s)
- Holbrook Kohrt
- Stanford Cancer Center, 875 Blake Wilbur Drive, MC5151, Stanford, CA 94305, USA
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Huang JJ, Jiang WQ, Lin TY, Huang Y, Xu RH, Huang HQ, Li ZM. Absolute lymphocyte count is a novel prognostic indicator in extranodal natural killer/T-cell lymphoma, nasal type. Ann Oncol 2010; 22:149-155. [PMID: 20595450 DOI: 10.1093/annonc/mdq314] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND extranodal natural killer (NK)/T-cell lymphoma (ENKL) is a heterogeneous entity with poor survival, requiring risk stratification in affected patients. We proposed absolute lymphocyte count (ALC) as a new prognostic factor in ENKL. PATIENTS AND METHODS we retrospectively analyzed 128 patients newly diagnosed with ENKL. Independent prognostic factors of survival were determined by Cox regression analysis. RESULTS patients with low ALC (<1.0 × 10(9)/l) at diagnosis tended to have more adverse clinical features. Patients with high ALC (≥1.0 × 10(9)/l) at diagnosis had better overall survival (OS; P < 0.0001) and progression-free survival (PFS; P<0.0001), and achieved higher complete remission rates (P=0.001). Multivariate analysis with known prognostic factors showed that ALC, B symptoms and advanced stage were independent predictors for OS and PFS. Using the International Prognostic Index, Prognostic Index for Peripheral T-cell lymphoma unspecified, or Korean Prognostic Index for nasal NK/T-cell lymphoma, the majority of patients were in the low-risk category (with no or one adverse factor). ALC was helpful to differentiate the low-risk patients with different survival outcomes (P < 0.0001). CONCLUSIONS our data suggest that ALC at diagnosis is a novel, powerful predictor of prognosis in ENKL. Immune status at diagnosis might have an important influence on survival in patients with ENKL.
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Affiliation(s)
- J J Huang
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology
| | - W Q Jiang
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology
| | - T Y Lin
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology
| | - Y Huang
- State Key Laboratory of Oncology in Southern China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - R H Xu
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology
| | - H Q Huang
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology
| | - Z M Li
- State Key Laboratory of Oncology in Southern China; Department of Medical Oncology.
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null-- zvlf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null,null,null-- gwaw] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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