Korean J Hematol 2012; 47(3):
Published online September 25, 2012
https://doi.org/10.5045/kjh.2012.47.3.202
© The Korean Society of Hematology
1Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Division of Hematology/Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
3Department of Pathology, Korea University Medical Center, Seoul, Korea.
4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Correspondence to : Correspondence to Won Seog Kim, M.D., Ph.D. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-6548, Fax: +82-2-3410-1754, wskimsmc@skku.edu
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Extranodal natural killer (NK)/T-cell lymphoma is a subtype of lymphoma that is derived from NK cells. It is considered as an aggressive form of non-Hodgkin's lymphoma because of frequent relapses and resistance to treatment. Relapsed NK/T-cell lymphoma often follows a fulminant course that is refractory to conventional chemotherapy treatment.
Several patients with extranodal NK/T-cell lymphoma showed long-term survival in spite of frequent relapses. Thus, the medical records of patients diagnosed with extranodal NK/T-cell lymphoma from 1995 to 2007 were reviewed and assessed.
Of the 140 cases reviewed, 6 were selected (4.29%). Each of these patients had a minimum of 3 relapses or disease progression during the follow-up period, and their median overall survival was 66 months (range, 42-89 months). They were grouped according to the atypical clinical behavior observed: (1) repeated relapses or progression (≥3 times) during follow-up; and (2) long-term survival of more than 40 months, as the longest overall survival median was previously considered at approximately 40 months. The clinicopathological and laboratory characteristics of these patients were similar to those of other extranodal NK/T-cell lymphoma patients. However, 5 of the studied cases involved relatively lower expression of the proliferation-related antigen Ki-67 (<40-50%), indicating less proliferative activity. Clinically, they showed delayed relapse for at least 20 months after the initial complete remission.
Our observations suggest that the clinical behavior of some extranodal NK/T-cell lymphoma patients differs from the typical clinical course.
Keywords Extranodal NK/T-cell lymphoma, Relapse, Survival, Indolent
Korean J Hematol 2012; 47(3): 202-206
Published online September 25, 2012 https://doi.org/10.5045/kjh.2012.47.3.202
Copyright © The Korean Society of Hematology.
Seok Jin Kim1, Yong Park2, Byung Soo Kim2, Insun Kim3, Young Hye Ko4, and Won Seog Kim1*
1Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Division of Hematology/Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
3Department of Pathology, Korea University Medical Center, Seoul, Korea.
4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Correspondence to: Correspondence to Won Seog Kim, M.D., Ph.D. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-6548, Fax: +82-2-3410-1754, wskimsmc@skku.edu
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Extranodal natural killer (NK)/T-cell lymphoma is a subtype of lymphoma that is derived from NK cells. It is considered as an aggressive form of non-Hodgkin's lymphoma because of frequent relapses and resistance to treatment. Relapsed NK/T-cell lymphoma often follows a fulminant course that is refractory to conventional chemotherapy treatment.
Several patients with extranodal NK/T-cell lymphoma showed long-term survival in spite of frequent relapses. Thus, the medical records of patients diagnosed with extranodal NK/T-cell lymphoma from 1995 to 2007 were reviewed and assessed.
Of the 140 cases reviewed, 6 were selected (4.29%). Each of these patients had a minimum of 3 relapses or disease progression during the follow-up period, and their median overall survival was 66 months (range, 42-89 months). They were grouped according to the atypical clinical behavior observed: (1) repeated relapses or progression (≥3 times) during follow-up; and (2) long-term survival of more than 40 months, as the longest overall survival median was previously considered at approximately 40 months. The clinicopathological and laboratory characteristics of these patients were similar to those of other extranodal NK/T-cell lymphoma patients. However, 5 of the studied cases involved relatively lower expression of the proliferation-related antigen Ki-67 (<40-50%), indicating less proliferative activity. Clinically, they showed delayed relapse for at least 20 months after the initial complete remission.
Our observations suggest that the clinical behavior of some extranodal NK/T-cell lymphoma patients differs from the typical clinical course.
Keywords: Extranodal NK/T-cell lymphoma, Relapse, Survival, Indolent
Patient clinical course. Abbreviations: CTx, chemotherapy; RTx, radiation therapy; CR, complete remission; PR, partial remission; PD, progression of disease.
Table 1 . Summary of patients..
a)Age at diagnosis. b)International prognostic index: Age, Performance, Extranodal involvement, Ann Arbor stage, serum LDH (Lactate dehydrogenase). Low: 0 or 1 risk factors, Low-Intermediate: 2 risk factors. c)NK-Prognostic index [4]: Presence of "B" symptoms, Ann Arbor stage ≥III, serum LDH >1×upper normal limit, and regional lymph node (N1-3, not M1). Group 1: none; Group 2: 1 risk factors; Group 3: 2 risk factors; Group 4: 3 or 4 risk factors. d)Time interval between the initial complete remission and the initial relapse..
Abbreviations: No, number; ECOG, Eastern Cooperative Oncology Group; PS, performance status; Sx, symptoms; LN, lymph node..
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Patient clinical course. Abbreviations: CTx, chemotherapy; RTx, radiation therapy; CR, complete remission; PR, partial remission; PD, progression of disease.