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Porte J, Hennequin C, Krizch D, Vercellino L, Guillerm S, Thieblemont C, Quéro L. Extranodal nasal-type NK/T lymphoma treated with chemotherapy and radiotherapy: case series from a European tertiary referral center and review of the literature. Strahlenther Onkol 2024; 200:434-443. [PMID: 37945929 DOI: 10.1007/s00066-023-02165-8] [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: 04/25/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE Extranodal nasal-type NK/T-cell lymphoma (ENKTL) is very rare in western countries and few data are available regarding the prognosis and the outcome of patients treated for this disease. We aimed to evaluate the prognosis, the pattern and risk factors of disease failure after combined therapy and also performed a review of the literature. PATIENTS AND METHODS We retrospectively analyzed 20 patients with (ENKTL) who underwent L‑Asparaginase based chemotherapy followed by (chemo-) radiotherapy between 2010 and 2020 in our center. Data on clinical characteristics and irradiation were collected. Failure patterns were recorded as local (tumor site), regional (regional lymph nodes) or distant failure (metastasis and/or nonregional lymph nodes). RESULTS During a median follow-up period of 46 months, disease failure was observed in 8 patients (40%). The 3‑year progression-free survival (PFS) and overall survival (OS) rates were 62.5 and 83.0%, respectively. The failure patterns were local (n = 6, 30%), regional (n = 3, 15%) and distant (n = 4, 20%). Among patients with local failure, all failures occurred within the radiation fields (100%). Univariate analysis showed that bilateral regional lymph node involvement (p = 0.0002), initial circulating EBV viral load ≥ 3.5 log (p = 0.03) and no negativation of EBV PCR after induction CT (p = 0.0497) were independent predictors of PFS. CONCLUSION Patients with bilateral lymph node involvement and/or high EBV viral load have a significant recurrence rate despite multimodal therapy. These results need to be confirmed by larger studies. Given the high rate of local recurrence within radiotherapy fields, the value of dose escalation should be considered. Patients at risk of relapse should be included in dedicated trials.
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Affiliation(s)
- Judith Porte
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Christophe Hennequin
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
- UMR/CEA, Immuno-Hematology Research Unit (SRHI), Université Paris Cité, Paris, France
| | - Daphné Krizch
- Hematology department, AP-HP, Hopital Saint Louis, Paris, France
| | - Laetitia Vercellino
- Nuclear Medicine Department, Hopital Saint Louis AP-HP, Paris, France
- INSERM, UMR_S942 MASCOT, Université Paris Cité, Paris, France
| | - Sophie Guillerm
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France
| | - Catherine Thieblemont
- Hematology department, AP-HP, Hopital Saint Louis, Paris, France
- INSERM U728, Universite Paris Cite, Paris, France
| | - Laurent Quéro
- Radiation Oncology department, AP-HP, Hopital Saint Louis, 1, Avenue Claude Vellefaux, 75010, Paris, France.
- INSERM U1160, Universite Paris Cite, Paris, France.
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Yu F, Wang J, Ke Z, Zhang Y, Xu L, Zhang H, Huang K, Cheng F, Yang H, Wang L, Wang Z, Shou L, Yu W, Fang H, Medeiros LJ, Wang W. EBV-positive Nodal T-Cell and NK-Cell Lymphoma: A Study of 26 Cases Including a Subset With Strong CD30 Expression Mimicking Anaplastic Large Cell Lymphoma. Am J Surg Pathol 2024; 48:406-416. [PMID: 38287746 DOI: 10.1097/pas.0000000000002184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Epstein-Barr virus (EBV)-positive nodal T-cell and NK-cell lymphoma is a rare neoplasm of cytotoxic T-cell or NK-cell lineage. Here, we report 26 cases affecting 14 men and 12 women with a median age of 52 years. All patients presented with disease involving multiple lymph nodes, and 20 of 22 (91%) fully staged patients had advanced Ann Arbor stage disease. Spleen, liver, and bone marrow were involved in 70%, 50%, and 52% of cases, respectively. These patients had a dismal prognosis with a median survival of 30 days. Histologically, lymph nodes were replaced by lymphoma in a diffuse pattern. Lymphoma cells were variable in size and large cell morphology was seen in 62% of cases. The neoplastic cells were CD4-/CD8- in 14 (54%) cases and CD4-/CD8+ in 12 (46%) cases. CD56 was positive in 14 (54%) cases. CD30 was positive in 20 (77%) cases; a strong and diffuse pattern was observed in 14 (54%) cases, mimicking, in part, anaplastic large cell lymphoma (ALCL). CD30 expression was associated with younger age and large cell morphology. In summary, EBV+ nodal T-cell and NK-cell lymphoma is an aggressive disease with a poor prognosis. These neoplasms are heterogeneous at the morphologic and immunophenotypic levels. Diffuse and strong expression of CD30 could potentially lead to a misdiagnosis of ALCL if EBV evaluation is not performed. Distinguishing between EBV+ nodal T-cell and NK-cell lymphoma from ALCL is important because treatment strategy and prognosis differ. CD30 expression offers a potential therapeutic target for patients with this aggressive disease.
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Affiliation(s)
| | | | - Zhonghe Ke
- Shanghai Rightongene Biotechnology Co., Ltd., Shanghai
| | - Yafei Zhang
- Positron Emission Tomography (PET) Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | | | | | | | | | | | | | | | - Lihong Shou
- Department of Hematology, Huzhou Central Hospital, Huzhou, China
| | | | - Hong Fang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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3
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Shen Z, Chen X, Sun C, Lu T, Shi Y, Zhang H, Ye J, Wang L, Zhu T, Miao Y, Zhang X, Wang L, Cai G, Sang W. Comparative analysis of clinicopathologic characteristics and prognosis between nasal and nonnasal extranodal NK/T-cell lymphoma. Cancer Med 2023; 12:21138-21147. [PMID: 37902266 PMCID: PMC10726883 DOI: 10.1002/cam4.6674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/04/2023] [Accepted: 10/04/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The clinicopathologic characteristics and prognosis of nasal and nonnasal extranodal natural killer T-cell lymphoma (ENKTL) are considered to be different. However, the underlying features responsible for these differences are not well clarified especially in the era of asparaginase therapy. METHODS In total, 1007 newly diagnosed ENKTL patients from 11 medical centers were included in this study. Clinicopathologic characteristics and survival data were collected. The chi-squared test and Kruskal-Wallis test were utilized for the comparison of different groups. Univariable and multivariable Cox proportional hazards models were used to screen prognostic factors. RESULTS Overall, 869 (86.3%) patients were nasal forms. Compared to patients with nasal ENKTL, nonnasal patients were at more advanced stages and had poor performance status, bone marrow involvement, elevated serum lactate dehydrogenase (LDH), and CD56-negative status (p < 0.05). The 5-year overall survival (OS) for nasal and nonnasal patients were 65.6% and 45.0%, respectively. The OS of nasal forms patients were superior to nonnasal patients, especially in Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2), advanced stage, KPI (HIR/HR), IPI (HIR/HR), PINK (HR), and high EBV DNA load groups. In patients treated with pegaspargase/L-asparaginase-based regimens, the OS of nasal patients was better than that of nonnasal patients. After adjusting the covariates of age, stage, ECOG PS score, LDH, B symptoms, and BM involvement, results showed that the nonnasal site was associated with poor survival of ENKTL. CONCLUSIONS The clinicopathologic characteristics and prognosis of nasal and nonnasal ENKTL patients are different. Nasal forms patients had superior OS than nonnasal patients, especially in the era of asparaginase.
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Affiliation(s)
- Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Xicheng Chen
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Cai Sun
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Tianyi Lu
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
| | - Yuye Shi
- Department of HematologyThe First People's Hospital of Huai'anHuai'anJiangsuChina
| | - Hao Zhang
- Department of HematologyThe Affiliated Hospital of Jining Medical UniversityJiningShandongChina
| | - Jingjing Ye
- Department of HematologyQilu Hospital of Shandong UniversityJinanShandongChina
| | - Ling Wang
- Department of HematologyTai'an Central HospitalTai'anShandongChina
| | - Taigang Zhu
- Department of HematologyThe General Hospital of Wanbei Coal‐Electric GroupSuzhouAnhuiChina
| | - Yuqing Miao
- Department of HematologyYancheng First People's HospitalYanchengJiangsuChina
| | - Xudong Zhang
- Department of HematologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Liang Wang
- Department of Hematology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiAnhuiChina
| | - Wei Sang
- Department of HematologyAffiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina
- Blood Diseases Institute, Xuzhou Medical UniversityXuzhouJiangsuChina
- Key Laboratory of Bone Marrow Stem CellXuzhouJiangsuChina
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4
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Desmirean M, Richlitzki C, Pasca S, Teodorescu P, Petrushev B, Rauch S, Steinheber J, Iluta S, Liu J, Dima D, Grewal R, Ma W, Qian L, Tomuleasa C. Correlation between the prevalence of T-cell lymphomas and alcohol consumption. Med Pharm Rep 2021; 94:298-306. [PMID: 34430851 DOI: 10.15386/mpr-1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/27/2020] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background and aims Alcohol is a psychoactive substance that causes dependence, with many thousands of years in the history of mankind, being widely used in different cultures. According to the International Agency for Research on Cancer, alcohol is involved in the development of cancer, being directly associated with it. Considering that alcohol is involved in the initiation and dissemination of gastrointestinal malignancies, the objective of the study was to assess its role in the pathogenesis of T-cell lymphomas, as well as its possible correlation with chronic consumption. Methods The patient cohort was compiled from the Sixth Medical Center of the People's Liberation Army Navy General Hospital in Beijing, China. A total of 30 patients matched the criteria and were enrolled in the study. Statistical analysis of the raw data was performed using R Statistics version R 3.5.1. released on the 29.08.2018. Results Our data demonstrate that the most common extranodal involvment of T-cell lymphoma patients is represented in decreasing order by bone marrow, peritoneum, rhino-oropharynx and the liver-biliary system. Nodal involvement is mainly represented in decreasing order by the laterocervical, axillary, mediastinal and inguinal regions. Conclusions These findings may be of value in further research and practical/clinical settings. Fever is the most common clinical feature and was present in most studied patients.
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Affiliation(s)
- Minodora Desmirean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pathology, Constantin Papilian Military Hospital, Cluj-Napoca, Romania
| | - Cedric Richlitzki
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Bobe Petrushev
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sebastian Rauch
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jacob Steinheber
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Jiaxin Liu
- Department of Hematology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania
| | - Ravnit Grewal
- South African Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.,South African Medical Research Council, Cape Town, South Africa.,Department of Hematology and Cell Biology, Faculty of Health Sciences, National Health Laboratory Services, University of the Free State, Bloemfontein, South Africa
| | - Weina Ma
- Department of Pathology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Liren Qian
- Department of Hematology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj-Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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5
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Li Z, Zhang X, Xue W, Zhang Y, Li C, Song Y, Mei M, Lu L, Wang Y, Zhou Z, Jin M, Bian Y, Zhang L, Wang X, Li L, Li X, Fu X, Sun Z, Wu J, Nan F, Chang Y, Yan J, Yu H, Feng X, Wang G, Zhang D, Fu X, Zhang Y, Young KH, Li W, Zhang M. Recurrent GNAQ mutation encoding T96S in natural killer/T cell lymphoma. Nat Commun 2019; 10:4209. [PMID: 31527657 PMCID: PMC6746819 DOI: 10.1038/s41467-019-12032-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 08/16/2019] [Indexed: 01/04/2023] Open
Abstract
Natural killer/T cell lymphoma (NKTCL) is a rare and aggressive malignancy with a higher prevalence in Asia and South America. However, the molecular genetic mechanisms underlying NKTCL remain unclear. Here, we identify somatic mutations of GNAQ (encoding the T96S alteration of Gαq protein) in 8.7% (11/127) of NKTCL patients, through whole-exome/targeted deep sequencing. Using conditional knockout mice (Ncr1-Cre-Gnaqfl/fl), we demonstrate that Gαq deficiency leads to enhanced NK cell survival. We also find that Gαq suppresses tumor growth of NKTCL via inhibition of the AKT and MAPK signaling pathways. Moreover, the Gαq T96S mutant may act in a dominant negative manner to promote tumor growth in NKTCL. Clinically, patients with GNAQ T96S mutations have inferior survival. Taken together, we identify recurrent somatic GNAQ T96S mutations that may contribute to the pathogenesis of NKTCL. Our work thus has implications for refining our understanding of the genetic mechanisms of NKTCL and for the development of therapies.
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Affiliation(s)
- Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Weili Xue
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Yanjie Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Chaoping Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Yue Song
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Mei Mei
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Lisha Lu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Yingjun Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Mengyuan Jin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Yangyang Bian
- Medical Research Centre, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Xiaoyan Feng
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China
| | - Guannan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Dandan Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China
| | - Xuefei Fu
- Novogene Bioinformatics Technology Co, Ltd, 38 Xueqing Road, 100083, Beijing, China
| | - Yuan Zhang
- The Academy of Medical Science of Zhengzhou University, 450052, Zhengzhou, China
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, China.
- Lymphoma Diagnosis and Treatment Center of Henan Province, 450000, Zhengzhou, China.
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Liu ZL, Bi XW, Zhang XW, Lei DX, Liu PP, Yang H, Gao Y, Jiang YX, Jiang WQ, Xia Y. Characteristics, Prognostic Factors, and Survival of Patients with NK/T-Cell Lymphoma of Non-upper Aerodigestive Tract: A 17-Year Single-Center Experience. Cancer Res Treat 2019; 51:1557-1567. [PMID: 30971067 PMCID: PMC6790852 DOI: 10.4143/crt.2018.681] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/28/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose The extranodal natural killer (NK)/T-cell lymphoma (NKTCL) of non-upper aerodigestive tract (NUAT) was found to have clinical heterogeneity compared with NKTCL of the upper aerodigestive tract (UAT) in small scale studies. We conducted this study in a much larger cohort to analyze the clinical characteristics, prognostic factors, treatment modality, and clinical outcomes of patients with NUAT-NKTCL. Materials and Methods From January 2001 to December 2017, a total of 757 NKTCL patients were identified and included in this study, including 92 NUAT-NKTCL patients (12.2%) and 665 UAT-NKTCLpatients (87.8%). Results NUAT-NKTCL patients had relatively poorer performance status, more unfavorable prognostic factors, and more advanced stage, compared with UAT-NKTCL patients. The 5-year overall survival (OS) was 34.7% for NUAT-NKTCL, which was significantly worse than UAT-NKTCL (64.2%, p<0.001). The median OS duration was 30.9 months for NUAT-NKTCL. Multivariate analysis showed that presence with B symptoms and elevated serum lactate dehydrogenase independently predicted worse OS. International prognostic index score and prognostic index of natural killer lymphoma score still had prognostic values in NUAT-NKTCL, while the Ann Arbor system could not accurately predict the OS. Conclusion NUAT-NKTCL is a distinctive subtype of NKTCL in many aspects. Patients with NUAT-NKTCL have relatively poorer performance status, more unfavorable prognostic factors, more advanced stage, and poorer prognosis.
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Affiliation(s)
- Ze-Long Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Xi-Wen Bi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Xue-Wen Zhang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - De-Xin Lei
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Pan-Pan Liu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Hang Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Yan Gao
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Yuan-Xue Jiang
- Department of Oncology, Pan Yu Central Hospital, Guangzhou, China
| | - Wen-Qi Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
| | - Yi Xia
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre of Cancer Medicine, Guangzhou, Korea
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7
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Yang W, Jiang S, Lin J, Li Y. CT findings predict survival of patients with peripheral T cell lymphoma: a preliminary study. Radiol Oncol 2019; 53:31-38. [PMID: 30681975 PMCID: PMC6411030 DOI: 10.2478/raon-2019-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023] Open
Abstract
Background Peripheral T-cell lymphoma (PTCL) is an uncommon disease with poor clinical outcomes. Radiological reports on the survival of patients with PTCL are scarce. The purpose of this study is to investigate the prognostic value of CT findings to predict clinical outcomes in fifty-one patients with histologically proven PTCL. Patients and methods The clinical data and CT images of all patients were retrospectively reviewed. CT features including number of involvement sites, lesion size, shape, margin, density, peritumoral invasion, intratumoral necrosis, lymph node involvement, and degree of contrast enhancement were evaluated. Univariate and multiple logistic regression analysis were used to determine the association between the clinical outcome and radiologic factors. Results Multiple site involvement, an ill-defined margin with peritumoral invasion, inhomogeneous density, and intratumoral necrosis were found to be associated with poor outcomes in univariate analysis (P < 0.05). An ill-defined margin with peritumoral invasion, was identified as an independent risk sign by further multivariate logistic regression analysis (P < 0.05). The area under the ROC curve of this CT feature was 0.745 (P < 0.05). Conclusions An ill-defined margin with peritumoral invasion was a valuable prognostic factor to predict the worse clinical outcomes in patients with PTCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anaplastic Lymphoma Kinase/analysis
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Area Under Curve
- Child
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Duodenal Neoplasms/diagnostic imaging
- Female
- Humans
- Logistic Models
- Lymphoma, T-Cell, Peripheral/diagnostic imaging
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Mediastinal Neoplasms/diagnostic imaging
- Middle Aged
- Multidetector Computed Tomography
- Necrosis
- Neoplasm Invasiveness
- Paranasal Sinus Neoplasms/diagnostic imaging
- Prednisone/administration & dosage
- Prognosis
- ROC Curve
- Retrospective Studies
- Tomography, Spiral Computed
- Treatment Outcome
- Vincristine/administration & dosage
- Young Adult
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Affiliation(s)
- Wenbin Yang
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Sen Jiang
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Jianbang Lin
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
| | - Yangkang Li
- Department of Radiology, Cancer Hospital, Shantou University Medical College, Guangdong, China
- Yangkang Li, Department of Radiology, Cancer Hospital, Shantou University Medical College, No7, Raoping Rd, Shantou, Guangdong Province 515041, P. R. China. Phone: +86 0754 8855 5844; Fax: +86 0754 8856 0352
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8
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Kim WY, Montes-Mojarro IA, Fend F, Quintanilla-Martinez L. Epstein-Barr Virus-Associated T and NK-Cell Lymphoproliferative Diseases. Front Pediatr 2019; 7:71. [PMID: 30931288 PMCID: PMC6428722 DOI: 10.3389/fped.2019.00071] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/21/2019] [Indexed: 12/14/2022] Open
Abstract
EBV-associated T and NK-cell lymphoproliferative diseases (EBV-T/NK LPDs) are characterized by the transformation and proliferation of EBV-infected T or NK cells. The 2016 revised World Health Organization classification recognizes the following EBV-positive lymphoproliferative disorders (LPD): chronic active EBV infection (CAEBV) of T- and NK-cell type (cutaneous and systemic forms), systemic EBV-positive T-cell lymphoma of childhood, aggressive NK-cell leukemia, extranodal NK/T-cell lymphoma, nasal type, and the new provisional entity primary EBV-positive nodal T/NK-cell lymphoma. EBV-associated hemophagocytic lymphohistiocytosis (HLH), although not included in the WHO classification because it is a reactive, inflammatory disease, is included in this review because it can be life-threatening and may have overlapping features with other EBV+ T/NK LPDs. EBV+ T/NK LPDs are rare diseases difficult to diagnose and manage properly, because some LPDs have unusual presentations, and discrepancies between clinical and histological findings might be encountered. Furthermore, EBV+ T/NK disorders share some clinico-pathological features, and may evolve into other categories during the clinical course, including malignant transformation of CAEBV. Here, we review the EBV+ T/NK LPDs in terms of their definitions, clinical features, histology, immunophenotype, molecular findings, and pathogenesis. This review aims to increase our understanding and awareness of the differential diagnosis among the different EBV+ T/NK LPDs. New insights into the genetic characteristics of these disorders will also be discussed.
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Affiliation(s)
- Wook Youn Kim
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany.,Department of Pathology, Konkuk University School of Medicine, Seoul, South Korea
| | - Ivonne A Montes-Mojarro
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center Tübingen, University Hospital Tübingen, Eberhard-Karls-University, Tübingen, Germany
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9
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Lee WJ, Moon IJ, Shin HJ, Won CH, Chang SE, Choi JH, Lee MW. CD30-positive cutaneous extranodal natural killer/T-cell lymphoma: clinicopathological features and survival outcomes. Int J Dermatol 2018; 58:688-696. [PMID: 30597548 DOI: 10.1111/ijd.14362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The prognostic value of CD30 expression in cutaneous extranodal natural killer/T-cell lymphoma is controversial. METHODS Clinicopathological features, survival outcomes, and prognostic implications of CD30 were retrospectively analyzed in 55 patients with cutaneous extranodal natural killer/T-cell lymphoma. We classified patients into (i) primary cutaneous extranodal natural killer/T-cell lymphoma and (ii) cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease depending on the primary tumor site. RESULTS CD30+ cutaneous extranodal natural killer/T-cell lymphoma was more common in patients with cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease than in those with primary cutaneous disease. CD30+ cases were more likely to present nodular lesions or cellulitis-like swelling than CD30- cases. Histologically, CD30+ cutaneous extranodal natural killer/T-cell lymphoma predominantly comprised large tumor cells compared with CD30- cases. However, the clinical morphology and tumor cell size were not associated with survival outcomes. CD30 expression was associated with better survival outcomes in patients with cutaneous extranodal natural killer/T-cell lymphoma secondary to nasal disease. CONCLUSION CD30+ cutaneous extranodal natural killer/T-cell lymphoma presented peculiar clinicopathological features and had more favorable disease course in patients with cutaneous dissemination from nasal disease.
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Affiliation(s)
- Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ik Jun Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Jeong Shin
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Kim SJ, Yoon SE, Kim WS. Treatment of localized extranodal NK/T cell lymphoma, nasal type: a systematic review. J Hematol Oncol 2018; 11:140. [PMID: 30567593 PMCID: PMC6300911 DOI: 10.1186/s13045-018-0687-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 12/12/2018] [Indexed: 12/18/2022] Open
Abstract
Extranodal natural killer/T cell lymphoma (ENKTL), nasal type, presents predominantly as a localized disease involving the nasal cavity and adjacent sites, and the treatment of localized nasal ENKTL is a major issue. However, given its rarity, there is no standard therapy based on randomized controlled trials and therefore a lack of consensus on the treatment of localized nasal ENKTL. Currently recommended treatments are based mainly on the results of phase II studies and retrospective analyses. Because the previous outcomes of anthracycline-containing chemotherapy were poor, non-anthracycline-based chemotherapy regimens, including etoposide and L-asparaginase, have been used mainly for patients with localized nasal ENKTL. Radiotherapy also has been used as a main component of treatment because it can produce a rapid response. Accordingly, the combined approach of non-anthracycline-based chemotherapy with radiotherapy is currently recommended as a first-line treatment for localized nasal ENKTL. This review summarizes the different approaches for the use of non-anthracycline-based chemotherapy with radiotherapy including concurrent, sequential, and sandwich chemoradiotherapy, which have been proposed as a first-line treatment for newly diagnosed patients with localized nasal ENKTL.
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Affiliation(s)
- Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Sang Eun Yoon
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
| | - Won Seog Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
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11
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Zhang L, Jia S, Ma Y, Li L, Li X, Wang X, Fu X, Ma W, Qin Y, Li W, Wu J, Sun Z, Zhang X, Nan F, Chang Y, Li Z, Zhang D, Wang G, Yan J, Su L, Wang J, Xue H, Young KH, Zhang M. Efficacy and safety of cisplatin, dexamethasone, gemcitabine and pegaspargase (DDGP) regimen in newly diagnosed, advanced-stage extranodal natural killer/T-cell lymphoma: interim analysis of a phase 4 study NCT01501149. Oncotarget 2018; 7:55721-55731. [PMID: 27384676 PMCID: PMC5342448 DOI: 10.18632/oncotarget.10124] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/11/2016] [Indexed: 12/17/2022] Open
Abstract
To explore a more effective treatment for newly diagnosed, advanced-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), we conducted a phase 4 study of the cisplatin, dexamethasone, gemcitabine, pegaspargase (DDGP) regimen. The primary end point was the 2-year progression-free survival (PFS) after the protocol treatment. Secondary endpoints included response rate (RR), overall survival (OS) and median survival time (MST). The interim analysis included data only from March 2011 to September 2013, who received six cycles of DDGP chemotherapy. A total of 25 eligible patients were enrolled. Seventeen patients (17/24, 70.83%) achieved complete response (CR) and four (4/24, 16.67%) achieved partial response (PR), three (3/24, 12.50%) had progressive disease (PD). The RR after treatment was 87.50%. After a median follow-up duration of 24.67 months (range 4-48 months). The 2-year PFS and OS rate were 61.80% (95% CI, 42.00% to 81.60%) and 68.50 % (95% CI, 48.70% to 88.30%), respectively. The MST was 36.55 months (95% CI, 29.41 months to 43.70 months). Grade 3/4 leukopenia occurred in fourteen patients (58.33%) and grade 3/4 thrombocytopenia occurred in eleven patients (45.83%). Twelve patients (50.00%) experienced Activated Partial Phromboplastin Ptime (APTT) elongation and fourteen patients (58.33%) experienced hypofibrinogenemia. In conclusion, DDGP regimen is an effective and tolerated treatment for newly diagnosed, advanced-stage ENKTL. This trial was registered at www.ClinicalTrials.gov as #NCT01501149.
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Affiliation(s)
- Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Sisi Jia
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yangyang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Wang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yanru Qin
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Dandan Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Guannan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Liping Su
- Department of Hematology, Shanxi Province 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
| | - Ken H Young
- Department of Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China
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12
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Abstract
T-cell lymphoma, a collection of subtypes of Non-Hodgkin lymphoma, is a rare malignancy. The low prevalence of this disease has made it challenging to identify subtype-specific risk factors. Potential risk factors could enable us to identify high-risk patients and predict patient outcomes. Here, we report on the current epidemiologic and prognostic factors data associated with the individual subtypes both of peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL) found in large cohort and case studies. Additionally, with recent findings, as well as updates in the new World Health Organization (WHO) classification of lymphoid neoplasms, we consider what this could do to change our approach to this group of diseases.
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13
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Wang X, Gong Z, Li SX, Yan W, Song Y. Extranodal nasal-type natural killer/T-cell lymphoma with penile involvement: a case report and review of the literature. BMC Urol 2017; 17:77. [PMID: 28874193 PMCID: PMC5585933 DOI: 10.1186/s12894-017-0273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/31/2017] [Indexed: 01/28/2023] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma (ENKTL) usually presents as a localized disease in the nasal cavity; extension to the male genitourinary system is very rare and has been characterized only recently. Most cases present with predominantly extranodal involvement, advanced stage disease, highly aggressive course, and strong association with Epstein-Barr virus (EBV). While metastasis is common in ENKTLs, the penis is rarely involved in both nasal and non-nasal ENKTLs and only one report was published to date. Case presentation One patient with NK/T-cell lymphoma, presented initially with a penile mass, is reported. The 58-year-old man who presented with progressive painless penile swelling underwent penectomy for penile tumor. Histologically, the glans and foreskin revealed neoplastic infiltration of medium-sized lymphoma cells expressing CD56, CD3, granzyme-B, and labeled for EBV-encoded RNA in situ hybridization. Findings were consistent with NK/T-cell lymphoma. By detailed history, we learned that the patient had nasal obstruction for more than 10 years. Nasopharyngeal involvement was screened with PET-CT; ENKTL was diagnosed after a nasopharyngeal biopsy. The final diagnosis was primary nasal NK/T-cell lymphoma, with metastasis to the penis. Additional sites of disease appeared soon afterward (adrenal gland, liver, spleen and lymph nodes). The patient died within 4 months. Conclusion This study suggested that penile NK/T-cell lymphoma tends to disseminate early and pursues an aggressive course. It is imperative to distinguish nasal NK/T lymphoma from other types of tumors, because the prognosis and treatment differ significantly for secondary metastases.
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Affiliation(s)
- Xiaotian Wang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Saohao Road, Shenyang, Liaoning, China
| | - Zimu Gong
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shawn Xiang Li
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China.,International College, China Medical University, Shenyang, China
| | - Wei Yan
- Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yongsheng Song
- Department of Urology, Shengjing Hospital of China Medical University, 36 Saohao Road, Shenyang, Liaoning, China.
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14
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Qian M, Tao H, Xu W, Ji H. A systematic comparison of treatment modalities for nasal extranodal natural killer/T-cell lymphoma in early stages between concurrent chemoradiotherapy and sequential chemotherapy. Onco Targets Ther 2017; 10:3617-3623. [PMID: 28790853 PMCID: PMC5530858 DOI: 10.2147/ott.s136386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Nasal extranodal natural killer/T-cell lymphoma (nasal ENKTL), which is strongly associated with the Epstein–Barr virus infection, is a common disease in Asia and Latin America. We conducted a retrospective study to compare the overall survival (OS) following concurrent or sequential treatment with radiotherapy and chemotherapy in patients with early stage ENKTL. Patients and methods The records of 58 cases from between 2000 to 2010 were retrieved. Of these, 28 patients (15 males, with median age of 51 years) were treated with sequential chemotherapy followed by radiotherapy (SCRT) and 30 patients (17 males, with median age of 46 years) were treated with concurrent chemoradiotherapy (CCRT). Subsequently, the OS, 5-year progression-free survival (PFS), 5-year locoregional-free survival (LRFS), and relevant toxicities were analyzed. Results There were no significant differences in the toxicities and complete response rate between the 2 groups (all P>0.05) during and immediately after treatment. Kaplan–Meier curve analysis demonstrated that there were significant differences between the CCRT and SCRT groups with regard to 5-year OS (72.9% vs 47.1%, P=0.029), 5-year PFS (68.8% vs 34.2%, P=0.030), and LRFS (78.9% vs 45.7%, P=0.026). Conclusion We have demonstrated that in comparison with SCRT, CCRT significantly improves the survival outcome in patients with localized ENKTL, with acceptable toxicities. Further clinical trials are needed.
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Affiliation(s)
- Ming Qian
- Department of Head and Neck Radiotherapy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Hengmin Tao
- Department of Head and Neck Radiotherapy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Wei Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Hongzhi Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
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15
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Xu Y, Wang J, Zhang W, Liu J, Cao X, He A, Chen Y, Gu L, Lei B, Zhang P, Ma X. Extended Course and Increased Dose of Initial Chemotherapy for Extranodal Nasal Type Natural Killer/T (NK/T)-Cell Lymphoma in Patients <60 Years Old: A Single-Center Retrospective Cohort Study. Med Sci Monit 2016; 22:4297-4311. [PMID: 27843135 PMCID: PMC5117239 DOI: 10.12659/msm.897650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/11/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Extranodal NK/T-cell lymphoma (ENKTL) of the nasal type is highly invasive and relatively resistant to chemotherapy. This study aimed to assess the efficacy and safety of an extended chemotherapy regimen with increased dose intensity. MATERIAL AND METHODS This was a retrospective cohort study of 69 patients <60 years old with an ECOG score 0-2 treated for ENKTL at the Second Affiliated Hospital of Xi'an Jiaotong University between January 2004 and December 2013. The outcomes were compared between patients who received >8 courses of high-intensity chemotherapy (n=37) vs. 6-8 courses (n=18) and <6 courses (n=14) of conventional chemotherapy. Regimens included improved CHOP, CHOP-E, EPOCH, MAED, MMED, SMILE, and Hyper-CVAD with an increased dose intensity in the >8 courses group. RESULTS The mean follow-up was 52 months (8 to 82 months). Remission rate did not differ significantly when compared among the 3 groups after 3 courses of chemotherapy (83.8%, 77.8%, and 78.6%, respectively, overall P=0.834), but the 5-year overall survival (OS) differed significantly (63.5%, 45.1%, and 22.9%, respectively, overall P=0.030), as did progression-free survival (PFS) (59.1%, 36.0%, and 15.1%, respectively, overall P=0.020), disease-free survival (DFS) (54.1%, 35.5%, and 12.9%, respectively, overall P=0.022), and total relapse rate throughout follow-up (37.04%, 50.0%, and 88.89%, respectively, overall P=0.027). There were no differences in adverse effects among the 3 groups. CONCLUSIONS These results suggest improved OS, PFS, DFS, and relapse rate in young patients with ENKTL receiving >8 courses of high-intensity chemotherapy.
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16
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Tian C, Yu Y, Zhang Y. A case report of primary cutaneous natural killer/T-cell lymphoma. Mol Clin Oncol 2016; 5:777-778. [PMID: 28101356 DOI: 10.3892/mco.2016.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 11/06/2022] Open
Abstract
Primary cutaneous extranodal natural killer/T-cell lymphoma, nasal type (ENKL-NT) is a relatively rare disease associated with aggressive tumor-cell behavior and poor prognosis. Progress in immunohistochemistry has improved the identification of ENKL-NT. The present case study reported on a 64-year-old female patient presenting with several red nodular lesions on the neck developed over four months. Cutaneous biopsy revealed these cells were positive for CD3, CD56, CD5, CD8 and negative for CD2, CD34, CD7, CD20 and Granzyme B. A computed tomography scan and bone marrow biopsy did not show any abnormalities and a diagnosis of primary cutaneous ENKL-NT was made. After treatment with chemotherapy regimens comprising cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), followed by high-dose treatment with methotrexate, dexamethasone, ifosfamide, etoposide and L-asparaginasum (SMILE), the patient succumbed to the disease. The present study exemplified that immunohistochemical analysis as well as the recognition of atypical lymphoid cells showing angiocentricity is crucial for the correct diagnosis of ENKL-NT. The prognosis of primary cutaneous ENKL-NT remains poor. As the CHOP regimen is not completely effective, high-dose chemotherapy, such as the SMILE regimen, is required.
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Affiliation(s)
- Chen Tian
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Yong Yu
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Yizhuo Zhang
- Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, P.R. China
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17
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Baykal C, Polat Ekinci A, Öztürk Sarı Ş, Topkarcı Z, Demir Ö, Büyükbabani N. Annular Erythematous Patches as the Presenting Sign of Extranodal Natural Killer/T-Cell Lymphoma. Turk J Haematol 2016; 33:360-361. [PMID: 27476759 PMCID: PMC5204199 DOI: 10.4274/tjh.2016.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | - Algün Polat Ekinci
- İstanbul University İstanbul Faculty of Medicine, Department of Dermatology and Venereology, İstanbul, Turkey, Phone: +90 212 635 29 39, E-mail:
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18
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Niu SQ, Yang Y, Li YY, Wen G, Wang L, Li ZM, Wang HY, Zhang LL, Xia YF, Zhang YJ. Primary site and regional lymph node involvement are independent prognostic factors for early-stage extranodal nasal-type natural killer/T cell lymphoma. CHINESE JOURNAL OF CANCER 2016; 35:34. [PMID: 27044275 PMCID: PMC4820898 DOI: 10.1186/s40880-016-0096-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
Background Nasal-type extranodal natural killer/T-cell lymphoma (ENKTCL) originates primarily in the nasal cavity or extra-nasal sites within the upper aerodigestive tract. However, it is unclear whether the primary site can serve as an independent prognostic factor or whether the varying clinical outcomes observed with different primary sites can be attributed merely to their propensities of regional lymph node involvement. The aim of this study was to investigate the prognostic implications of the primary site and regional lymph node involvement in patients with early-stage nasal-type ENKTCL. Methods To develop a nomogram, we reviewed the clinical data of 215 consecutively diagnosed patients with early-stage nasal-type ENKTCL who were treated in Sun Yat-sen University Cancer Center with chemotherapy and radiotherapy between 2000 and 2011. The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index (C-index) and calibration curve. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates of patients with nasal ENKTCL were higher than those of patients with extra-nasal ENKTCL (OS: 68.2% vs. 46.0%, P = 0.030; PFS: 53.4% vs. 26.6%, P = 0.010). The 5-year OS and PFS rates of patients with Ann Arbor stage IE ENKTCL were higher than those of patients with Ann Arbor stage IIE ENKTCL (OS: 66.3% vs. 59.2%, P = 0.003; PFS: 51.4% vs. 40.3%, P = 0.009). Multivariate analysis showed that age >60 years, ECOG performance status score ≥2, elevated lactate dehydrogenase (LDH) level, extra-nasal primary site, and regional lymph node involvement were significantly associated with lower 5-year OS rate; age >60 years, elevated LDH level, extra-nasal primary site, and regional lymph node involvement were significantly associated with lower 5-year PFS rate. The nomogram included the primary site and regional lymph node involvement based on multivariate analysis. The calibration curve showed good agreement between the predicted and actual 5-year OS and PFS rates, and the C-indexes of the nomogram for the OS and PFS rates were 0.697 and 0.634, respectively. Conclusions The primary site and regional lymph node involvement are independent prognostic factors for early-stage ENKTCL treated with chemotherapy followed by definitive radiotherapy.
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Affiliation(s)
- Shao-Qing Niu
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510060, Guangdong, P.R. China
| | - Yong Yang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Cancer Hospital and Institute, Peking Union Medical College (PUMC) and Chinese Academy of Medical Sciences (CAMS), Beijing, 100021, P.R. China
| | - Yi-Yang Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Ge Wen
- Department of Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong, P.R. China
| | - Liang Wang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Hematological Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Han-Yu Wang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Lu-Lu Zhang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China
| | - Yu-Jing Zhang
- State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China. .,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P.R. China.
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Cao X, Cui F, Wei J, Wang Q, Deng LC, Liu BR, Shen WS. Hearing loss due to metastasis of gastric cancer to temporal bone: A case report. Oncol Lett 2016; 11:1305-1308. [PMID: 26893735 PMCID: PMC4734266 DOI: 10.3892/ol.2016.4084] [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: 11/18/2014] [Accepted: 09/29/2015] [Indexed: 11/16/2022] Open
Abstract
Metastatic temporal bone tumors are rare, and tend to be asymptomatic. The clinical symptoms consist of aural discharge, bleeding, hearing loss and facial nerve paresis. The most common origin of the metastasis is breast cancer, and other sites of the primary tumor include the thyroid gland, brain, lungs, prostate and blood. Clinical reports of hearing loss due to gastric cancer metastatic to temporal bone are rare. In the present study, a case of gastric cancer metastasis to temporal bone without other organ involvement is described. The patient presented with the symptom of hearing loss, and the metastatic tumor was diagnosed by radiological imaging, including magnetic resonance imaging, computed tomography and bone scan.
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Affiliation(s)
- Xiangming Cao
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu 214400, P.R. China; The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Fangbo Cui
- Department of Oncology, The People's Hospital of Ma Anshan, Ma Anshan, Anhui 243000, P.R. China
| | - Jia Wei
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Qing Wang
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Li Chun Deng
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu 214400, P.R. China
| | - Bao Rui Liu
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School and Clinical Cancer Institute of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Wei Sheng Shen
- Department of Oncology, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, Jiangsu 214400, P.R. China
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Icaritin induces lytic cytotoxicity in extranodal NK/T-cell lymphoma. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2015; 34:17. [PMID: 25887673 PMCID: PMC4336495 DOI: 10.1186/s13046-015-0133-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/04/2015] [Indexed: 11/22/2022]
Abstract
Background Extranodal NK/T-cell lymphoma (ENKL) is an aggressive hematological malignancy associated with Epstein–Barr virus (EBV) infection. It is often resistant to conventional chemotherapy and has a poor prognosis. Icaritin, a compound derived from Chinese herbal medicine, Herba Epimedii, has been reported to exert antitumor effects on a variety of cancer cell lines. In the present study, we investigated the cytotoxic effects of Icaritin on the two EBV-positive ENKL cell lines SNK-10 and SNT-8, along with the underlying molecular mechanisms. Methods ENKL cell lines SNK-10 and SNT-8 were exposed to different concentrations of Icaritin for the indicated time. Treated cells were analyzed for cell proliferation, cell cycle, and cell apoptosis. Phosphorylation of Stat3 and Akt proteins in signaling pathways and the EBV-encoded LMP1 proteins were measured by Western blot. Expression of EBV genes was assessed by Real-Time PCR. Results Our results showed that Icaritin dose-dependently inhibits ENKL cell proliferation and induces apoptosis and cell cycle arrest at G2/M phase. Additionally, Icaritin upregulates Bax, downregulates Bcl-2 and pBad, and activates caspase-3 and caspase-9. The anti-proliferative and pro-apoptotic effects of Icaritin are likely mediated by inhibition of Stat3 and Akt pathways through LMP1 downregulation. Importantly, Icaritin induces EBV lytic gene expression in ENKL cells, and the combination of Icaritin and the antiviral drug ganciclovir (GCV) is more effective in inducing ENKL cells apoptosis than Icaritin or GCV alone. Conclusions These findings indicate that EBV-targeted approaches may have significant therapeutic potential for ENKL treatment.
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21
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Prognostic value of carbohydrate tumor markers and inflammation-based markers in metastatic or recurrent gastric cancer. Med Oncol 2014; 31:289. [PMID: 25344872 DOI: 10.1007/s12032-014-0289-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 10/11/2014] [Indexed: 12/18/2022]
Abstract
We examined the relationship between hematological parameters and clinicopathologic significance in metastatic or recurrent gastric cancer (MRGC) patients, and construct a prognostic index for MRGC patients. We retrospectively reviewed the medical records of 439 patients with MRGC. Tumor markers, inflammation-based markers such as mGPS (which combines CRP and albumin concentrations), NLR, PLR and other hematological parameters were observed in the study. CA125 was more frequently positive with peritoneal recurrence, and CEA was more frequently positive in patients with liver metastases. In the univariate analysis of survival, the following variables were associated with shorter overall survival (OS): male, previous pathology such as nerves invasion and vessel invasion, elevated CEA, CA72-4, CA125 and CA19-9, and inflammation-based variables such as Alb, CRP, mGPS, PLR, NLR, Hb, LDH, AchE and AKP. In the multivariate analysis, mGPS, CEA and CA125 were independent prognostic factors for OS. An exploration of the potential prognostic index model including the three independent factors was carried out, MSTs for the low-, moderate- and high-risk groups were 12, 10.5 and 5 months. Elevated serum CEA, CA125 and mGPS in patients with MRGC are independent negative predictor of prognosis. And the prognostic index was constructed to predict prognosis of MRGC patients more accurately.
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Lin N, Song Y, Zheng W, Tu M, Xie Y, Wang X, Ping L, Ying Z, Zhang C, Deng L, Liu W, Zhu J. A prospective phase II study of L-asparaginase- CHOP plus radiation in newly diagnosed extranodal NK/T-cell lymphoma, nasal type. J Hematol Oncol 2013; 6:44. [PMID: 23816178 PMCID: PMC3734195 DOI: 10.1186/1756-8722-6-44] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/15/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To explore the efficacy and safety of L-asparaginase in newly-diagnosed extranodal nature killer (NK)/T -cell lymphoma (ENKTL), we conducted a prospective phase II study of L-asparaginase, cyclophosphamide, vincristine, doxorubicin and dexamethasone (CHOP-L) regimen in combination with radiotherapy. PATIENTS AND METHODS Patients with newly diagnosed ENKTL and an ECOG performance status of 0 to 2 were eligible for enrollment. Treatment included 6-8 cycles of CHOP-L (cyclophosphamide, 750 mg/m(2) day 1; vincristine, 1.4 mg/m(2) day 1 (maximal dose 2 mg), doxorubicin 50 mg/m(2) day 1; dexamethasone 10 mg days 1-8; L-asparaginase 6000 u/m(2) days 2-8). Radiotherapy was scheduled after 4-6 cycles of CHOP-L regimen, depending on stage and primary anatomic site. The primary endpoint was complete response (CR) rate. RESULTS A total of 38 eligible patients were enrolled. The median age was 40.5 years (range, 15 to 71 years). Their clinical characteristics were male to female ratio, 24:14; Ann Arbor stage I, 20; II, 11; III, 3; IV, 4. CR and overall response rates were 81.6% (95% CI, 69.3% to 93.9%) and 84.2%, respectively. With a median follow-up of 25 months, the 2-year overall survival, progression-free survival and disease-free survival rates were 80.1% (95%CI, 73.3% to 86.9%), 81% (95%CI, 74.5% to 87.5%) and 93.6% (95%CI, 89.3% to 97.9%), respectively. The major adverse events were myelosuppression, liver dysfunction, and digestive tract toxicities. Grade 3 to 4 leukopenia and neutropenia were 76.3% and 84.2%, respectively. No treatment-related death was observed. CONCLUSION CHOP-L chemotherapy in combination with radiotherapy is a safe and highly effective treatment for newly diagnosed ENKTL.
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Mahuad CV, Bilbao ER, Garate GM, de Los Ángeles Vicente Repáraz M, Del Olmo M, Casali CÉ, Zerga ME, Chirife AM, Cicco JA. Primary NK/T cell lymphoma nasal type of the colon. Rare Tumors 2013; 5:e9. [PMID: 23772308 PMCID: PMC3682461 DOI: 10.4081/rt.2013.e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 01/25/2013] [Accepted: 01/26/2013] [Indexed: 11/22/2022] Open
Abstract
Since nasal NK/T-cell lymphoma and NK/T-cell lymphoma nasal type are rare diseases, colonic involvement has seldom been seen. We report a case of a patient with a primary NK/T-cell lymphoma nasal type of the colon. The patient had no history of malignant diseases and was diagnosed after exhaustive study in the context of fever of unknown origin. The first therapeutic approach followed the DA-EPOCH-protocol: etoposide, prednisone, doxor-rubicin, vincristine and cyclophosphamide. The persistence of constitutional symptoms after the first treatment course motivated the switch to a second line following the SMILE-protocol: dexamethasone, metotrexate, ifosfamide, E.coli L-asparaginase, and etoposide. Despite intensive chemotherapy, the patient died 2 months after the diagnose of an extranodal NK/T-cell lymphoma of the colon and 4 months after the first symptomatic appearance of disease.
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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: 17] [Impact Index Per Article: 1.5] [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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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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Tang T, Tay K, Quek R, Tao M, Tan SY, Tan L, Lim ST. Peripheral T-cell lymphoma: review and updates of current management strategies. Adv Hematol 2010; 2010:624040. [PMID: 21234357 PMCID: PMC3018617 DOI: 10.1155/2010/624040] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/14/2010] [Indexed: 01/08/2023] Open
Abstract
The classification of T-cell and natural-killer- (NK-) cell lymphomas has been updated in the 4th edition of the World Health Organization (WHO) classification of tumors of the haematopoietic and lymphoid tissue published in 2008. Based on recent epidemiological studies, NK-cell lymphomas occur almost exclusively in Asia and South America, although T-cell lymphomas appear to occur in the East as commonly as in the West. Due to the low prevalence of this disease, diagnosis and optimal treatment of patients have not been studied prospectively in large randomized trials. Nevertheless, there has been development in the understanding of T-cell lymphomas and how they should be managed; FDG-PET emerges as an increasingly important tool in diagnosis, gene-expression signatures may aid with prognostication in the future, and novel therapies are currently being studied to improve outcomes in T-cell lymphomas. More work, however, needs to be done, and international collaboration will be pertinent to deriving meaningful results from future clinical studies.
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Affiliation(s)
- Tiffany Tang
- Department of Medical Oncology, The National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Kevin Tay
- Department of Medical Oncology, The National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Richard Quek
- Department of Medical Oncology, The National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Miriam Tao
- Department of Medical Oncology, The National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
| | - Soo Yong Tan
- Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608
| | - Leonard Tan
- Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608
| | - Soon Thye Lim
- Department of Medical Oncology, The National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610
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Kim SJ, Kim WS. Treatment of localized extranodal NK/T cell lymphoma, nasal type. Int J Hematol 2010; 92:690-6. [PMID: 21086194 DOI: 10.1007/s12185-010-0720-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 10/19/2010] [Accepted: 10/27/2010] [Indexed: 01/21/2023]
Abstract
Extranodal NK/T cell lymphoma predominantly presents as a localized disease in the upper aerodigestive tract from the nasal cavity to the hypopharynx. Because radiotherapy has better outcomes than chemotherapy with reduced locoregional failure, it should be considered the preferred first-line therapy. However, the addition of chemotherapy is appropriate as part of the initial treatment because of the frequent systemic progression or relapse after radiotherapy. At present, the combination of radiotherapy and chemotherapy can be considered an effective treatment option, and the promising results of recent prospective studies with concurrent chemoradiotherapy support this treatment strategy. In contrast, intensive chemotherapy should be considered as initial treatment for patients with tumors in non-upper-aerodigestive-tract sites, such as skin or intestine because they usually progress to systemic disease. Likewise, for patients with poor prognostic factors, such as a high NK lymphoma prognostic index, autologous stem cell transplantation during remission and additional treatments with central nervous system prophylaxis may be beneficial. However, the precise role of these treatments needs to be clarified further by prospective clinical trials. Thus, a prospective study is warranted to explore a risk-adapted treatment strategy of applying initial chemoradiotherapy and additional consolidation treatments.
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Affiliation(s)
- Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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Kobold S, Merz H, Tiemann M, Mahuad C, Bokemeyer C, Koop I, Fiedler W. Primary NK/T cell lymphoma nasal type of the stomach with skin involvement: a case report. Rare Tumors 2009; 1:e58. [PMID: 21139937 PMCID: PMC2994465 DOI: 10.4081/rt.2009.e58] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 12/15/2022] Open
Abstract
Since nasal NK/T cell lymphoma and NK/T cell lymphoma nasal type are rare diseases, gastric involvement has seldom been seen. We report a unique case of a patient with a primary NK/T cell lymphoma nasal type of the stomach with skin involvement. The patient had no history of malignant diseases and was diagnosed with hematemesis and intense bleeding from his gastric primary site. Shortly after this event, exanthemic skin lesions appeared with concordant histology to the primary site. Despite chemotherapy, the patient died one month after the first symptomatic appearance of disease.
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Affiliation(s)
- Sebastian Kobold
- Department of Oncology/Hematology/ Bone Marrow Transplantation/ Pneumology, University Medical Center Eppendorf
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