Volume 37, Issue S2 pp. 477-478
PTCL AND NK/T CELL LYMPHOMAS
Free Access

TREATMENT AND OUTCOMES OF PATIENTS WITH NK/T-CELL LYMPHOMA TREATED WITH MODIFIED (m)SMILE AND INTENSITY-MODULATED RADIOTHERAPY (IMRT), A SINGLE CENTER EXPERIENCE

P. Ghione

P. Ghione

Lymphoma Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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S. Qi

S. Qi

Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Shi, China

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B.S. Imber

B.S. Imber

Department of Radiation Oncology, Memorial Sloan Ketterin Cancer Center, New York, United States

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S. Venkatraman

S. Venkatraman

Department of Epidemiology and Biostatistics, Memorial Sloan Ketterin Cancer Center, New York, United States

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A. Moskowitz

A. Moskowitz

Lymphoma Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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N. Galasso

N. Galasso

Lymphoma Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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M. Lunning

M. Lunning

Oncology and Hematology, University of Nebraska Medical Center, Omaha, United States

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D. Straus

D. Straus

Lymphoma Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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C. Sauter

C. Sauter

Bone Marrow Transplant Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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P. Dahi

P. Dahi

Bone Marrow Transplant Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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A. Dogan

A. Dogan

Hematopathology Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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J. Yahalom

J. Yahalom

Department of Radiation Oncology, Memorial Sloan Ketterin Cancer Center, New York, United States

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S.M. Horwitz

S.M. Horwitz

Lymphoma Service, Memorial Sloan Ketterin Cancer Center, New York, United States

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First published: 12 June 2019

Introduction: Extranodal NK/T cell lymphoma (ENKTL) is a rare subtype of lymphoma, poorly responsive to anthracycline-based chemotherapy. Treatment and prognosis are largely driven by stage, and the PINK and PINK-E scores appear to further refine it. Outcomes for patients with ENKTL have improved with L-asparaginase containing regimens into combined modality approaches. Based on the reported efficacy of SMILE (Yamaguchi, Cancer Sci, 2008), in 2009, we adopted a modified (m)SMILE (dexamethasone, methotrexate, ifosfamide, peg-asparaginase, etoposide) regimen given every 3 weeks, followed by radiotherapy (RT) as our standard approach. Main differences from the SMILE are: I) shorter course of chemotherapy, II) the use of peg-asparaginase (most common dose was 1500 U/m2), and III) lower dose and Intensity-Modulated Radiotherapy (IMRT) consolidation.

Methods: We retrospectively analyzed 28 patients with ENKTL treated at our institution with mSMILE from 10/2009–3/2019. Early-stage patients were planned to receive 2 cycles of mSMILE+IMRT, advanced stage 3-4 cycles of mSMILE+/-IMRT. We collected patient characteristics and estimated survival with the Kaplan-Meier method.

Results: Patient characteristics were: age median 52y (24-69); female 53%; Asian 25%, other races 75%. Response post mSMILE was 93% (26/28, CR 68%) and response post IMRT was 95% (23/24, CR 87.5%). After a median follow-up of 31 months (range 5-105) 17 patients are alive (61%). Among early-stage patients (IE)/low PINK-E (n=13), overall survival (OS) was 100% at the median follow up, and progression-free survival (PFS) was 92%. However, there were two subsequent events: one death due to relapse and one death from unrelated causes in remission. Intermediate and high-risk stage/PINK-E patients fared similarly, with an OS of 43% and a PFS of 33.3% at the median follow-up. Four pts (14%) had chemotherapy dose reductions, 9 pts (32%) experienced G3-4 non-hematologic toxicity, all pts had hematologic toxicity, for 21/28 (75%) G3-4. Twenty-four pts, (86%) received RT as part of their treatment course. 22/24 received IMRT consolidation post 1-2 mSMILE 16 with receiving 4500 cGy. Of these 22, 2 pts received IMRT consolidation composite with total body irradiation conditioning for allo-transplant to total doses of 3947 cGy. An example of IMRT field design is shown in the figure.

Discussion: In 28 patients treated at MSKCC for newly diagnosed ENKTL with mSMILE+/-IMRT, we confirmed the overall high response rate with mSMILE. This is a highly active albeit aggressive approach with good results in patients with early-stage/favorable risk disease for whom the PFS and OS were excellent. However, outcomes remain inadequate for those with more extensive disease or higher risk factors. For these patients, the recent identification of new agents including pembrolizumab and daratumumab raise the possibility of novel regimens or approaches.

Keywords: extranodal lymphomas; L-asparaginase; T-cell lymphoma (TCL).

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