Extranodal NK-T-cell lymphoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Ramyar Ghandriz MD[2]

## Overview

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The predominant therapy for extranodal NK-T-cell lymphoma is radiation therapy. Adjudicative chemotherapy and stem cell transplant may be required.

## Medical Therapy

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* The predominant therapy for extranodal NK-T-cell lymphoma is radiation therapy. Adjudicative chemotherapy and stem cell transplant may be required.[1]
* Therapy of extranodal NK/T cell lymphoma depends on staging of the tumor:[2][3][4][5]

Stage  | Involvement  | Common involvement place  | Preferred therapy method  | Radiation dosage  | Chemotherapy regimen  | Alternative therapy  | Over 69 /severe organ damage/low lymphocyte

|
|
|
|
|
|
|

I(E)  | Single extranodal involvement  | upper aerodigestive tract  | Combined modality therapy‡  | 50 Gy RT  | DeVIC∞  | 40 Gy RT + weekly Cisplatin  | \-
II(E)  | Stage I(E) +One or more of † involvements  | upper aerodigestive tract  | Combined modality therapy  | 50 Gy RT  | DeVIC  | 40 Gy RT + weekly Cisplatin  | \-
III(E)•  | Stage I (E) + Cervical lymph node involvement + infra diaphragmatic lymph node / Involvement of spleen  | Systemic /

Disseminated

| SMILE៛  | \-  | \-  | \-  | Less intensive L-asparaginase-containing chemotherapy
IV  | Stage I(E) +isolated distant involvement  | Systemic /

Disseminated

| SMILE  | \-  | \-  | \-  | Less intensive L-asparaginase-containing chemotherapy

†: Cervical lymph node involvement / Involvement of other supradiaphragmatic lymph node regions / Isolated involvement of additional sites in the head and neck

•: Rare

‡: Combined modality therapy is radiation therapy with concurrent chemotherapy

∞: Dexamethasone, Etoposide, Ifosfamide, Carboplatin.

៛: Dexamethasone. Methotrexate, Ifosfamide, L-asparaginase, Etoposide

Treatment of extranodal NK-T-cell lymphoma[1] Therapy  | Description

|

Radiation therapy  |

* If extranodal NK-T-cell lymphoma is confined to the nose or nasal passages, external beam radiation therapy is used

Chemotherapy  |

* Chemotherapy is often added to radiation therapy to treat extranodal NK/T-cell lymphoma
* If extranodal NK-T-cell lymphoma is more widespread, then chemotherapy may be more intense and higher doses may be used
* Drug regimen: (CHOP) Cyclophosphamide AND Doxorubicin AND Vincristine AND Prednisone
* CNS Prophylaxis: Methotrexate

Stem cell transplant  |

* May be offered to some people with extranodal NK-T-cell lymphoma who relapse after initial treatment

## References

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1. ↑ 1.0 1.1 Extranodal NK/T-cell lymphoma, nasal type. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/non-hodgkin-lymphoma/types-of-nhl/extranodal-nk-t-cell-lymphoma-nasal-type/?region=on. Accessed on February 02, 2016
2. ↑ Dreyling, M.; Thieblemont, C.; Gallamini, A.; Arcaini, L.; Campo, E.; Hermine, O.; Kluin-Nelemans, J. C.; Ladetto, M.; Le Gouill, S.; Iannitto, E.; Pileri, S.; Rodriguez, J.; Schmitz, N.; Wotherspoon, A.; Zinzani, P.; Zucca, E. (2013). "ESMO Consensus conferences: guidelines on malignant lymphoma. part 2: marginal zone lymphoma, mantle cell lymphoma, peripheral T-cell lymphoma". Annals of Oncology. 24 (4): 857–877. doi:10.1093/annonc/mds643. ISSN 1569-8041.
3. ↑ Isobe, Koichi; Uno, Takashi; Tamaru, Jun-ichi; Kawakami, Hiroyuki; Ueno, Naoyuki; Wakita, Hisashi; Okada, Jun-ichi; Itami, Jun; Ito, Hisao (2006). "Extranodal natural killer/T-cell lymphoma, nasal type". Cancer. 106 (3): 609–615. doi:10.1002/cncr.21656. ISSN 0008-543X.
4. ↑ Li, Ye-Xiong; Yao, Bo; Jin, Jing; Wang, Wei-Hu; Liu, Yue-Ping; Song, Yong-Wen; Wang, Shu-Lian; Liu, Xin-Fan; Zhou, Li-Qiang; He, Xiao-Hui; Lu, Ning; Yu, Zi-Hao (2006). "Radiotherapy As Primary Treatment for Stage IE and IIE Nasal Natural Killer/T-Cell Lymphoma". Journal of Clinical Oncology. 24 (1): 181–189. doi:10.1200/JCO.2005.03.2573. ISSN 0732-183X.
5. ↑ Kim, Seok Jin; Yang, Deok-Hwan; Kim, Jin Seok; Kwak, Jae-Yong; Eom, Hyeon-Seok; Hong, Dae Sik; Won, Jong Ho; Lee, Jae Hoon; Yoon, Dok Hyun; Cho, Jaeho; Nam, Taek-Keun; Lee, Sang-wook; Ahn, Yong Chan; Suh, Cheolwon; Kim, Won Seog (2014). "Concurrent chemoradiotherapy followed by l-asparaginase-containing chemotherapy, VIDL, for localized nasal extranodal NK/T cell lymphoma: CISL08-01 phase II study". Annals of Hematology. 93 (11): 1895–1901. doi:10.1007/s00277-014-2137-6. ISSN 0939-5555.

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