Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes

Jonathan E. Brammer, Dai Chihara, L. Michelle Poon, Paolo Caimi, Marcos de Lima, Celina Ledesma, Gabriela Rondon, Stefan O. Ciurea, Yago Nieto, Michelle Fanale, Bouthaina Dabaja, Richard T. Maziarz, Richard E. Champlin, Chitra Hosing, Yasuhiro Oki

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4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e41-e50
JournalClinical Lymphoma, Myeloma and Leukemia
Volume18
Issue number1
DOIs
StatePublished - Jan 2018

Keywords

  • Extranodal natural killer/T-cell lymphoma
  • SMILE
  • advanced stage
  • refractory disease
  • stem cell transplant

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Brammer, J. E., Chihara, D., Poon, L. M., Caimi, P., de Lima, M., Ledesma, C., Rondon, G., Ciurea, S. O., Nieto, Y., Fanale, M., Dabaja, B., Maziarz, R. T., Champlin, R. E., Hosing, C., & Oki, Y. (2018). Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes. Clinical Lymphoma, Myeloma and Leukemia, 18(1), e41-e50. https://doi.org/10.1016/j.clml.2017.10.001