Nasal NK/T-cell lymphoma with disseminated disease treated with aggressive combined therapy.

Agustin Avilés, Natividad Neri, Raúl Fernández, Angel Calva, Judith Huerta-Guzmán, M Jesús Nambo

Journal: Medical oncology (Northwood, London, England) 2003;20(1):13-7

PMID: 12665679

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Abstract

Thirty-two patients with nasal NK/T-cell lymphoma and disseminated disease (lung, skin, and bone marrow) were treated with an intensive combined therapy that consisted of three cycles of CMED (cyclophosphamide 2 g/m(2), metothrexate 200 mg/m(2), etoposide 600 mg/m(2), and dexamethasone 80 mg/m(2) with leucovorin rescue administered 24 h after) every 14 d, following high-dose radiotherapy: 55 Gy in 20 sesions to centrofacial region and three cycles more of the same chemotherapy regimen. To ameliorate the presence of severe granulocytopenia, granulocyte colony-stimulating factor, 5 microg/kg, daily for 14 d, begun on d 2 after chemotherapy, was administered. Complete response was achieved in 21 cases (65%); failure or progression was observed in 11 cases (35%). With a median follow-up of 69.1 mo, relapse has not been observed; thus, actuarial curves at 5 yr showed that event-free survival (EFS) is 100% in 21 patients and overall survival (OS) is 65%. Granulocytopenia grade IV was observed in 15% cycles, Nonhematological toxicity was mild and well tolerated. Radiotherapy was well tolerated; only mild mucositis was observed. Nasal NK/T-cell lymphoma is an rare presentation of malignant lymphoma (<1% of all cases) with a worse prognosis; less than 5% patients are alive free of disease at 1 yr. The use of intensive more specific chemotherapy and high dose of local radiotherapy, appear to be an excellent therapeutic approach with improvement in EFS and OS.

Address: Oncological Research Unit, Oncology Hospital, National Medical Center, IMSS, México. [email protected]

DOI: 10.1385/MO:20:1:13

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MeSH Terms: Adult, Aged, Agranulocytosis, Antineoplastic Combined Chemotherapy Protocols, Bone Marrow Neoplasms, Cyclophosphamide, Dexamethasone, Disease-Free Survival, Etoposide, Female, Follow-Up Studies, Granulocyte Colony-Stimulating Factor, Humans, Killer Cells, Natural, Leucovorin, Lung Neoplasms, Lymphoma, T-Cell, Male, Methotrexate, Middle Aged, Nose Neoplasms, Radiotherapy, Adjuvant, Remission Induction, Skin Neoplasms, Treatment Outcome