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How we treat NK/T-cell lymphomas.

Eric Tse1, Wei-Li Zhao2, Jie Xiong2

  • 1Department of Medicine, Professorial Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.

Journal of Hematology & Oncology
|June 6, 2022
PubMed
Summary

Natural killer (NK)/T-cell lymphomas are aggressive cancers linked to Epstein-Barr virus (EBV). Treatment focuses on EBV DNA levels and PET/CT scans, using non-anthracycline regimens and stem cell transplants for advanced cases.

Keywords:
Aggressive leukaemia/lymphomaAsparaginaseImmune checkpointNK/T-cell lymphomaNasalNon-nasalPD1Radiotherapy

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Area of Science:

  • Oncology
  • Hematology
  • Virology

Background:

  • Natural killer (NK)/T-cell lymphomas are aggressive cancers with a global prevalence, particularly in Asian and South American populations.
  • Epstein-Barr virus (EBV) infection is a universal characteristic of these lymphomas.
  • These lymphomas present in distinct clinical subtypes: nasal, non-nasal, and aggressive leukemia/lymphoma.

Purpose of the Study:

  • To outline the diagnostic and prognostic parameters for NK/T-cell lymphomas.
  • To detail current therapeutic strategies and their goals.
  • To explore novel and future treatment approaches for relapsed or refractory cases.

Main Methods:

  • Initial assessment involves positron emission tomography computed tomography (PET/CT) imaging, plasma EBV DNA quantification, and bone marrow examination.
  • Prognostication utilizes presentation parameters (age, stage, EBV DNA) and dynamic treatment parameters (serial EBV DNA, interim/end-of-treatment PET/CT).
  • Treatment strategies involve asparaginase-based regimens, radiotherapy, and allogeneic hematopoietic stem cell transplantation (HSCT).

Main Results:

  • Therapeutic goals include achieving undetectable plasma EBV DNA and normal PET/CT (Deauville score ≤ 3).
  • Anthracycline-containing regimens are ineffective due to multidrug resistance.
  • Stage I/II nasal cases are treated with non-anthracycline asparaginase-based regimens and radiotherapy; advanced stages and other subtypes receive asparaginase regimens consolidated with allogeneic HSCT.

Conclusions:

  • Effective treatment of NK/T-cell lymphomas requires tailored, non-anthracycline approaches and monitoring of EBV DNA and PET/CT response.
  • Allogeneic HSCT is a key consolidation therapy for suitable patients with advanced disease.
  • Emerging strategies like immune checkpoint blockade and targeted therapies offer promise for relapsed/refractory NK/T-cell lymphomas.