TY - JOUR
T1 - Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma
T2 - An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes
AU - Brammer, Jonathan E.
AU - Chihara, Dai
AU - Poon, L. Michelle
AU - Caimi, Paolo
AU - de Lima, Marcos
AU - Ledesma, Celina
AU - Rondon, Gabriela
AU - Ciurea, Stefan O.
AU - Nieto, Yago
AU - Fanale, Michelle
AU - Dabaja, Bouthaina
AU - Maziarz, Richard T.
AU - Champlin, Richard E.
AU - Hosing, Chitra
AU - Oki, Yasuhiro
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/1
Y1 - 2018/1
N2 - We present a cohort of primarily non-Asian patients with advanced stage and relapsed/refractory ENKL. Our results demonstrate that achievement of complete response (CR) is imperative at all stages of disease in order to attain long-term disease control. The SMILE regimen was effective in relapsed/refractory disease to achieve complete remission. Autologous stem cell transplant should be strongly considered in patients with advanced ENKL who achieved CR, whereas allo-SCT can be considered for select patients who have not attained a CR. Background Extra-Nodal natural killer/T-cell lymphoma (ENKL) is a rare lymphoma representing approximately 5-10% of T-cell non-Hodgkin lymphomas diagnosed in the United States each year. Patients with advanced stage III/IV ENKL and relapsed refractory ENKL have a poor prognosis even despite aggressive therapy and stem cell transplantation (SCT). We conducted a review of the management of 37 patients with advanced-stage and relapsed/refractory ENKL in a predominantly non-Asian cohort evaluating both chemotherapy and SCT outcomes. Patients and Methods We evaluated clinical outcomes in all patients treated for advanced stage III/IV or relapsed/refractory ENKL at MD Anderson cancer center between 2000-2014. Next, we collected stem cell transplant data from four transplant institutions to further evaluate outcomes of both allogeneic (allo-SCT) and autologous (auto-SCT) stem cell transplantation in ENKL. Results OS and PFS were 73% and 45% at one year, and 30% and 19% at 3-years, respectively. SMILE chemotherapy was more effective in maintaining a CR compared to CHOP (83% vs 17%). Only achievement of CR was prognostic for OS (HR 0.245, p=0.002) and PFS (HR 0.072, p) Conclusion Our results suggest that achievement of a CR is imperative in patients with advanced ENKL, and is desirable for any patient for whom auto-SCT is utilized. SMILE-based chemotherapy appeared effective in attaining a CR, and was also an effective salvage regimen. For patients attaining a first CR, auto-SCT should be strongly considered, but should definitely be utilized in patients attaining CR2. For patients with refractory disease, allo-SCT can be considered in a selected group of patients.
AB - We present a cohort of primarily non-Asian patients with advanced stage and relapsed/refractory ENKL. Our results demonstrate that achievement of complete response (CR) is imperative at all stages of disease in order to attain long-term disease control. The SMILE regimen was effective in relapsed/refractory disease to achieve complete remission. Autologous stem cell transplant should be strongly considered in patients with advanced ENKL who achieved CR, whereas allo-SCT can be considered for select patients who have not attained a CR. Background Extra-Nodal natural killer/T-cell lymphoma (ENKL) is a rare lymphoma representing approximately 5-10% of T-cell non-Hodgkin lymphomas diagnosed in the United States each year. Patients with advanced stage III/IV ENKL and relapsed refractory ENKL have a poor prognosis even despite aggressive therapy and stem cell transplantation (SCT). We conducted a review of the management of 37 patients with advanced-stage and relapsed/refractory ENKL in a predominantly non-Asian cohort evaluating both chemotherapy and SCT outcomes. Patients and Methods We evaluated clinical outcomes in all patients treated for advanced stage III/IV or relapsed/refractory ENKL at MD Anderson cancer center between 2000-2014. Next, we collected stem cell transplant data from four transplant institutions to further evaluate outcomes of both allogeneic (allo-SCT) and autologous (auto-SCT) stem cell transplantation in ENKL. Results OS and PFS were 73% and 45% at one year, and 30% and 19% at 3-years, respectively. SMILE chemotherapy was more effective in maintaining a CR compared to CHOP (83% vs 17%). Only achievement of CR was prognostic for OS (HR 0.245, p=0.002) and PFS (HR 0.072, p) Conclusion Our results suggest that achievement of a CR is imperative in patients with advanced ENKL, and is desirable for any patient for whom auto-SCT is utilized. SMILE-based chemotherapy appeared effective in attaining a CR, and was also an effective salvage regimen. For patients attaining a first CR, auto-SCT should be strongly considered, but should definitely be utilized in patients attaining CR2. For patients with refractory disease, allo-SCT can be considered in a selected group of patients.
KW - Extranodal natural killer/T-cell lymphoma
KW - SMILE
KW - advanced stage
KW - refractory disease
KW - stem cell transplant
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U2 - 10.1016/j.clml.2017.10.001
DO - 10.1016/j.clml.2017.10.001
M3 - Article
C2 - 29277360
AN - SCOPUS:85039946745
SN - 2152-2650
VL - 18
SP - e41-e50
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 1
ER -