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Blood Res 2020; 55(S1):

Published online July 31, 2020

https://doi.org/10.5045/br.2020.S011

© The Korean Society of Hematology

Extranodal NK/T cell lymphoma

Seong Hyun Jeong

Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea

Correspondence to : Seong Hyun Jeong, M.D.
Department of Hematology-Oncology, Ajou University School of Medicine, 21, World cup-ro 150beon-gil, Yeongtong-gu, Suwon 16500, Korea
E-mail: seonghyunmd@naver.com

Received: November 24, 2019; Revised: January 21, 2020; Accepted: January 22, 2020

This is an Open Access article distributed unAcute myeloid leukemia, New FDA approvalsder the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Extranodal natural killer (NK)/T cell lymphoma (ENKTL) is a distinct subtype of Non-Hodgkin’s lymphoma mainly involving the nasal area. Since the entity was first recognized, treatment strategies have been evolving from anthracycline-based chemotherapy and radiotherapy to L-asparaginase containing regimens and recently immune checkpoint inhibitors. With the currently used combined chemotherapy and radiotherapy, more than 70% of patients with localized disease can be cured. L-asparaginase containing regimens have significantly improved treatment outcomes among patients with advanced disease. However, the treatment outcomes of patients with disease refractory to L-asparaginase containing regimens or who experience recurrence remain poor. In this article, we cover the current treatments for ENKTL and emerging treatment approaches.

Keywords Extranodal natural killer/T cell lymphoma, ENKTL, Non-Hodgkin’s lymphoma, Immunotherapy

Article

Review Article

Blood Res 2020; 55(S1): S63-S71

Published online July 31, 2020 https://doi.org/10.5045/br.2020.S011

Copyright © The Korean Society of Hematology.

Extranodal NK/T cell lymphoma

Seong Hyun Jeong

Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea

Correspondence to:Seong Hyun Jeong, M.D.
Department of Hematology-Oncology, Ajou University School of Medicine, 21, World cup-ro 150beon-gil, Yeongtong-gu, Suwon 16500, Korea
E-mail: seonghyunmd@naver.com

Received: November 24, 2019; Revised: January 21, 2020; Accepted: January 22, 2020

This is an Open Access article distributed unAcute myeloid leukemia, New FDA approvalsder the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Extranodal natural killer (NK)/T cell lymphoma (ENKTL) is a distinct subtype of Non-Hodgkin’s lymphoma mainly involving the nasal area. Since the entity was first recognized, treatment strategies have been evolving from anthracycline-based chemotherapy and radiotherapy to L-asparaginase containing regimens and recently immune checkpoint inhibitors. With the currently used combined chemotherapy and radiotherapy, more than 70% of patients with localized disease can be cured. L-asparaginase containing regimens have significantly improved treatment outcomes among patients with advanced disease. However, the treatment outcomes of patients with disease refractory to L-asparaginase containing regimens or who experience recurrence remain poor. In this article, we cover the current treatments for ENKTL and emerging treatment approaches.

Keywords: Extranodal natural killer/T cell lymphoma, ENKTL, Non-Hodgkin’s lymphoma, Immunotherapy

Table 1 . Treatment strategies for localized (stage IE/IIE) ENKTL..

RegimenTreatmentNORR/CR (%)OS/PFS (%)Grade III/IV neutropenia (%)
Concurrent therapy
DeVIC [38, 39]Simultaneous RT 50 Gy+DeVIC×33377/7670/63 (5-yr)91
VIPD [40]CCRT (weekly cisplatin+RT 40–50.8 Gy)3083/8086/85 (3-yr)47
→VIPD×3
VIDL [41]CCRT (weekly cisplatin+RT 40–44Gy)3090/8760/73 (5-yr)80
→VIDL×3
MIDDLE [42]CCRT (weekly cisplatin, L-asparaginase×3+RT 36–44 Gy)→MIDDLE×22886/8282/74 (3-yr)91
GDP [43]CCRT (weekly cisplatin+IMRT 56 Gy)→GDP×33291/8488/84 (3-yr)41 (leukopenia)
MPVIC-P [44]Simultaneous RT 56 Gy+intra-arterial12100/100100/100 (5-yr)33
MPVIC-P
Sequential therapy
SMILE [44]SMILE→RT→SMLIE17NA/82NANA
LVP [32, 47]LVP→IFRT→LVP2689/8165/64 (5-yr)31 (grade 3)
GELOX [31, 48]GELOX→IFRT2796/7486/86 (2-yr)NA
P-GEMOX [49]P-GEMOX×2→RT 56 Gy3394/8083/77 (2-yr)33.3
DICE-L [50]DICE-L×3→RT 45 Gy27NA/9189/82 (5-yr)4.4 (leukopenia)

Abbreviations: CR, complete remission; ENKTL, Extranodal NK/T cell lymphoma; NA, not available; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; PR, partial remission; RT, radiotherapy..


Table 2 . New treatment targets for ENKTL..

TargetTreatmentPatientsOutcomeReference
PD-1/PD-L1Pembrolizumab7 relapsed5 CR, 2 PR[69]
Nivolumab3 relapsed3 CR[71]
CD38Daratumumab2 RR1 CR, 1 PR[74, 75]
CD30BV2 refractory2 CR[79, 80]
CCR4MogamulizumabPreclinicalNA[85]
LMP1/LMP2Autologous CTLs11 ENKTL6 active disease5 in CR9 CR 4 CR 5 remained CR[86]
Autologous CTLs10 ENKTL in CR9 remained CR[87]
JAK/STATVorinostat1 pediatric ENKTLCR[89]
RuxolitinibClinical trialOngoing[NCT02974647]

Abbreviations: BV, brentuximab vedotin; CR, complete remission; CTL, cytotoxic T lymphocyte; ENKTL, extranodal NK/T cell lymphoma; PR, partial remission; RR, refractory/relapsed..


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