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Extranodal natural killer/T-cell lymphoma involving the gastrointestinal tract: analysis of clinical features and outcomes from the Asia Lymphoma Study Group.

Kim SJ, Jung HA, Chuang SS, Hong H, Guo CC, Cao J, Hong XN, Suzuki R, Kang HJ, Won JH, Chng WJ, Kwong YL, Suh C, Song YQ, Zhu J, Tay K, Lim ST, Suzumiya J, Lin TY, Kim WS, Asia Lymphoma Study Gro - J Hematol Oncol (2013)

Bottom Line: The most common GI site was the small intestine, including the jejunum and ileum (n = 57, 70.3%).Thus, the median overall survival was 7.8 months (95% Confidence interval: 3.9 - 11.7 months).Thus, more effective treatment strategies are required for this disease entity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. TongyuLim@hotmail.com.

ABSTRACT

Background: The gastrointestinal (GI) tract is one of the most common extranasal sites in extranodal NK/T-cell lymphoma (ENKTL). However, data regarding ENKTL involving the GI tract are relatively scarce. Thus, we performed a multicenter, multinational retrospective study to analyze clinical features and treatment outcomes of ENKTL involving the GI tract.

Patients and methods: Patients with ENKTL involving the GI tract diagnosed in twelve participating centers between 1991 and 2012 were retrospectively analyzed from five Asian countries.

Results: The analysis of 81 patients with ENKTL involving the GI tract revealed that more than 60% of patients presented as advanced disease with B symptoms. 55 patients (68%) had GI manifestations including abdominal pain (n = 26, 32%), GI tract bleeding (n = 17, 21%) and bowel perforation (n = 12, 15%). The most common GI site was the small intestine, including the jejunum and ileum (n = 57, 70.3%). There were 34 patients (42%) who received systemic chemotherapy while 33 patients (41%) underwent surgery plus chemotherapy. However, 35 patients (43%) died due to disease progression, and treatment-related mortality including sepsis occurred in 17 patients (21%). Thus, the median overall survival was 7.8 months (95% Confidence interval: 3.9 - 11.7 months). Patients who could undergo surgery plus chemotherapy showed a trend of better survival than those treated with chemotherapy alone.

Conclusion: Overall, the data indicated that ENKTL involving the GI tract has a dismal prognosis despite active treatment including chemotherapy and surgery. Thus, more effective treatment strategies are required for this disease entity.

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Analysis of survival outcomes based on treatments. (A) The comparison of overall survival shows better survival of patients treated with surgery plus chemotherapy with marginal significance compared to chemotherapy alone. (B) The comparison of overall survival according to the type of chemotherapy regimen, CHOP versus non-anthracycline based chemotherapy (non-CHOP) shows no difference in the surgery plus chemotherapy group. (C) In the chemotherapy group, there is no difference between CHOP and non-CHOP regimens.
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Figure 4: Analysis of survival outcomes based on treatments. (A) The comparison of overall survival shows better survival of patients treated with surgery plus chemotherapy with marginal significance compared to chemotherapy alone. (B) The comparison of overall survival according to the type of chemotherapy regimen, CHOP versus non-anthracycline based chemotherapy (non-CHOP) shows no difference in the surgery plus chemotherapy group. (C) In the chemotherapy group, there is no difference between CHOP and non-CHOP regimens.

Mentions: With the median potential follow-up of 54.0 months (95% Confidence interval (CI): 31.6 – 76.4 months), the median OS was only 7.8 months (95% CI: 3.9 – 11.7 months). A total of 54 patients died, including two patients who did not receive any curative treatment. Among the 79 patients who received surgery or chemotherapy or both, 35 patients died due to disease progression while non-disease-related deaths were found in 17 patients (Figure 3A). Sepsis accounted for 70% of non-disease-related death (12/17), with seven patients dying from sepsis after chemotherapy. In patients treated with surgery plus chemotherapy, two patients died due to graft-versus host disease (GVHD) after allogeneic HSCT, and the remaining two other deaths included surgical complication-related death and suicide (Figure 3A). The comparison of outcomes according to chemotherapy regimens showed no significant difference in the cause of deaths among patients who received CHOP or SMILE regardless of surgery although the proportion of disease-related death was lower in patients who received SMILE (35%, 6/17) than CHOP (57%, 21/37, Figure 3B). The median OS of patients treated with surgery plus chemotherapy was 21.3 months (95% CI: 8.2 – 34.4 months) whereas the median OS of chemotherapy or surgery alone was 7.2 (95% CI: 3.0 – 11.4 months) and 1.7 months (95% CI: 0.36 – 3.0 months), respectively. Thus, surgery followed by chemotherapy showed a tendency toward better outcomes compared with chemotherapy (Figure 4A). However, these results might be related to the fact that patients who received chemotherapy had more advanced disease and unfavorable characteristics compared with patients who underwent surgery plus chemotherapy (Table 2). When we compared the OS according to chemotherapy regimens, patients who received non-anthracycline-based or intensified regimens did not show a significant survival difference compared with patients who received CHOP or CHOP-like regimens regardless of surgery (Figure 4B, C). The comparison of CHOP with SMILE also showed no survival difference (data not shown).


Extranodal natural killer/T-cell lymphoma involving the gastrointestinal tract: analysis of clinical features and outcomes from the Asia Lymphoma Study Group.

Kim SJ, Jung HA, Chuang SS, Hong H, Guo CC, Cao J, Hong XN, Suzuki R, Kang HJ, Won JH, Chng WJ, Kwong YL, Suh C, Song YQ, Zhu J, Tay K, Lim ST, Suzumiya J, Lin TY, Kim WS, Asia Lymphoma Study Gro - J Hematol Oncol (2013)

Analysis of survival outcomes based on treatments. (A) The comparison of overall survival shows better survival of patients treated with surgery plus chemotherapy with marginal significance compared to chemotherapy alone. (B) The comparison of overall survival according to the type of chemotherapy regimen, CHOP versus non-anthracycline based chemotherapy (non-CHOP) shows no difference in the surgery plus chemotherapy group. (C) In the chemotherapy group, there is no difference between CHOP and non-CHOP regimens.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4225665&req=5

Figure 4: Analysis of survival outcomes based on treatments. (A) The comparison of overall survival shows better survival of patients treated with surgery plus chemotherapy with marginal significance compared to chemotherapy alone. (B) The comparison of overall survival according to the type of chemotherapy regimen, CHOP versus non-anthracycline based chemotherapy (non-CHOP) shows no difference in the surgery plus chemotherapy group. (C) In the chemotherapy group, there is no difference between CHOP and non-CHOP regimens.
Mentions: With the median potential follow-up of 54.0 months (95% Confidence interval (CI): 31.6 – 76.4 months), the median OS was only 7.8 months (95% CI: 3.9 – 11.7 months). A total of 54 patients died, including two patients who did not receive any curative treatment. Among the 79 patients who received surgery or chemotherapy or both, 35 patients died due to disease progression while non-disease-related deaths were found in 17 patients (Figure 3A). Sepsis accounted for 70% of non-disease-related death (12/17), with seven patients dying from sepsis after chemotherapy. In patients treated with surgery plus chemotherapy, two patients died due to graft-versus host disease (GVHD) after allogeneic HSCT, and the remaining two other deaths included surgical complication-related death and suicide (Figure 3A). The comparison of outcomes according to chemotherapy regimens showed no significant difference in the cause of deaths among patients who received CHOP or SMILE regardless of surgery although the proportion of disease-related death was lower in patients who received SMILE (35%, 6/17) than CHOP (57%, 21/37, Figure 3B). The median OS of patients treated with surgery plus chemotherapy was 21.3 months (95% CI: 8.2 – 34.4 months) whereas the median OS of chemotherapy or surgery alone was 7.2 (95% CI: 3.0 – 11.4 months) and 1.7 months (95% CI: 0.36 – 3.0 months), respectively. Thus, surgery followed by chemotherapy showed a tendency toward better outcomes compared with chemotherapy (Figure 4A). However, these results might be related to the fact that patients who received chemotherapy had more advanced disease and unfavorable characteristics compared with patients who underwent surgery plus chemotherapy (Table 2). When we compared the OS according to chemotherapy regimens, patients who received non-anthracycline-based or intensified regimens did not show a significant survival difference compared with patients who received CHOP or CHOP-like regimens regardless of surgery (Figure 4B, C). The comparison of CHOP with SMILE also showed no survival difference (data not shown).

Bottom Line: The most common GI site was the small intestine, including the jejunum and ileum (n = 57, 70.3%).Thus, the median overall survival was 7.8 months (95% Confidence interval: 3.9 - 11.7 months).Thus, more effective treatment strategies are required for this disease entity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Division of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. TongyuLim@hotmail.com.

ABSTRACT

Background: The gastrointestinal (GI) tract is one of the most common extranasal sites in extranodal NK/T-cell lymphoma (ENKTL). However, data regarding ENKTL involving the GI tract are relatively scarce. Thus, we performed a multicenter, multinational retrospective study to analyze clinical features and treatment outcomes of ENKTL involving the GI tract.

Patients and methods: Patients with ENKTL involving the GI tract diagnosed in twelve participating centers between 1991 and 2012 were retrospectively analyzed from five Asian countries.

Results: The analysis of 81 patients with ENKTL involving the GI tract revealed that more than 60% of patients presented as advanced disease with B symptoms. 55 patients (68%) had GI manifestations including abdominal pain (n = 26, 32%), GI tract bleeding (n = 17, 21%) and bowel perforation (n = 12, 15%). The most common GI site was the small intestine, including the jejunum and ileum (n = 57, 70.3%). There were 34 patients (42%) who received systemic chemotherapy while 33 patients (41%) underwent surgery plus chemotherapy. However, 35 patients (43%) died due to disease progression, and treatment-related mortality including sepsis occurred in 17 patients (21%). Thus, the median overall survival was 7.8 months (95% Confidence interval: 3.9 - 11.7 months). Patients who could undergo surgery plus chemotherapy showed a trend of better survival than those treated with chemotherapy alone.

Conclusion: Overall, the data indicated that ENKTL involving the GI tract has a dismal prognosis despite active treatment including chemotherapy and surgery. Thus, more effective treatment strategies are required for this disease entity.

Show MeSH
Related in: MedlinePlus