Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: A study of 136 cases from the International Peripheral T-Cell Lymphoma Project

Among 1153 new adult cases of peripheral/T-cell lymphoma from 1990-2002 at 22 centers in 13 countries, 136 cases (11.8%) of extranodal natural killer (NK)/T-cell lymphoma were identified (nasal 68%, extranasal 26%, aggressive/unclassifiable 6%). The disease frequency was higher in Asian than in Western countries and in Continental Asia than in Japan. There were no differences in age, sex, ethnicity, or immunophenotypic profile between the nasal and extranasal cases, but the latter had more adverse clinical features. The median overall survival (OS) was better in nasal compared with the extranasal cases in early- (2.96 vs 0.36 years, P < .001) and late-stage disease (0.8 vs 0.28 years, P = .031). The addition of radiotherapy for early-stage nasal cases yielded survival benefit (P = .045).Among nasal cases, both the International Prognostic Index (P = .006) and Korean NK/T-cell Prognostic Index (P < .001) were prognostic. In addition, Ki67 proliferation greater than 50%, transformed tumor cells greater than 40%, elevated C-reactive protein level (CRP), anemia (< 11 g/dL) and thrombocytopenia (< 150 × 10 9/L) predicts poorer OS for nasal disease. No histologic or clinical feature was predictive in extranasal disease. We conclude that the clinical features and treatment response of extranasal NK/T-cell lymphoma are different from of those of nasal lymphoma. However, the underlying features responsible for these differences remain to be defined. © 2009 by The American Society of Hematology.link_to_OA_fulltex

Clinical differences between nasal and extranasal natural killer/T-cell lymphoma:a study of 136 cases from the International Peripheral T-Cell Lymphoma Project.

Among 1153 new adult cases of peripheral/T-cell lymphoma from 1990-2002 at 22 centers in 13 countries, 136 cases (11.8%) of extranodal natural killer (NK)/T-cell lymphoma were identified (nasal 68%, extranasal 26%, aggressive/unclassifiable 6%). The disease frequency was higher in Asian than in Western countries and in Continental Asia than in Japan. There were no differences in age, sex, ethnicity, or immunophenotypic profile between the nasal and extranasal cases, but the latter had more adverse clinical features. The median overall survival (OS) was better in nasal compared with the extranasal cases in early- (2.96 vs 0.36 years, P < .001) and late-stage disease (0.8 vs 0.28 years, P = .031). The addition of radiotherapy for early-stage nasal cases yielded survival benefit (P = .045). Among nasal cases, both the International Prognostic Index (P = .006) and Korean NK/T-cell Prognostic Index (P < .001) were prognostic. In addition, Ki67 proliferation greater than 50%, transformed tumor cells greater than 40%, elevated C-reactive protein level (CRP), anemia (< 11 g/dL) and thrombocytopenia (< 150 x 10(9)/L) predicts poorer OS for nasal disease. No histologic or clinical feature was predictive in extranasal disease. We conclude that the clinical features and treatment response of extranasal NK/T-cell lymphoma are different from of those of nasal lymphoma. However, the underlying features responsible for these differences remain to be defined

HIGH DOSE CHEMOTHERAPY WITH AUTOLOGOUS STEM CELL SUPPORT IN FIRST LINE TREATMENT OF AGGRESSIVE NON HODGKIN LYMPHOMA: RESULTS OF AN INDIVIDUAL PATIENT DATA META-ANALYSIS

Background. Randomised controlled trials (RCTs) reported conflicting results on the impact of high-dose chemotherapy (HDCT) and autologous stem cell transplantation in the first-line treatment of patients with aggressive non-Hodgkin Lymphoma (NHL). Aims and Methods. We performed a meta-analysis based on individual patient data (IPD) to assess the efficacy of HDCT compared to conventional chemotherapy in aggressive NHL patients with regard to overall survival (OS) and progression-free survival (PFS). Furthermore, we wanted to determine the efficacy on the intervention in specific subgroups of patients. Particularly we analysed the impact of the age-adjusted International Prognostic Index (aaIPI). We searched the Cochrane Library, MEDLINE and other databases (1/1990 to 12/2007). The RCTs were conducted mainly without Rituximab. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using the Cox proportional hazards model stratified by study. The conventional chemotherapy-arm is taken as reference in the analysis. Results. Individual patient data were available from 11 RCTs including 2,132 randomised patients. Information on patient characteristics, treatment, events and survival was collected. Overall, there was no evidence for HDCT to improve OS (HR 1.09; 95% CI 0.95-1.24) or PFS (HR 1.04; 95% CI 0.92-1.17) when compared with conventional chemotherapy. In subgroup analysis hazard ratios for OS was 1.34 (95% CI 0.98-1.82) for good risk patients and 1.01 (95% CI 0.87-1.17) for poor risk patients (p value for interaction = 0.10). Subgroup analysis did not indicate differences in terms of PFS between good (HR 1.07, 95% CI 0.84-1.36) and poor risk (HR 0.99, 95% CI 0.87-1.14) patients (p value for interaction = 0.61). Summary and Conclusions. Preliminary analyses suggest that there is no evidence for HDCT to improve OS or PFS in NHL patients compared to conventional chemotherapy. There was no evidence for different treatment outcomes in patients with good or poor IPI risk group. Further results will be presented