Publication

Abstract : Background: Nasal NK –T cell lymphoma accounts for 5% of all NHLs at our centre. Methods: We reviewed data of 38 patients treated between January 2002 and August 2013. Results: Patients’ median age was 40 yrs (12-75 yrs),M:F = 3.2:1. 8/38 had unilateral loss of vision at presentation, 23/38 (60%) had B symptoms; median duration of symptoms was 3.5 months. Sinuses were involved in 24/38 cases, common being maxillary (42%) and ethmoid (41 %). Palate was perforated in 14 (36 %) cases. Ann Arbor staging revealed; stage I-30/38(79%), II-4/38 (10.5 %) and IV in 4 patients (10.5 %), 4 patients had lung and 1 had both lung and brain involvement. IPI score(n=28) was 1 in 7 patients(25 %), 2 in 13 (46 %),3 in 3 patients(10 %), and 4 -5 in 5 patients (18 %).Patients received CHOP (n= 20) and L-asparaginase based chemotherapy (SMILE, Yamaguchi et al, JCO, 2011;29(33):4410-16, n=11) 2011 onwards. Radiation dose (IFRT) was 45Gy to 50 Gys in 25 fractions (CHOP-10, SMILE-5). Response rates at end of treatment; CHOP-CR -8/20, PR-0, SMILE- CR-7/11, PR-4/11. 4 patients relapsed; CHOP-3, SMILE-1. Among 20 patients in CHOP arm, 5 (25 %) are alive in CR, 6 died of progressive disease, and 9 were lost to follow up, of which 3 were in CR. In the SMILE group 6 of 11 patients are alive in CR and 1 died of progression. In the SMILE cohort (n=11), major toxicities were - neutropenic fever-6, grade 3 thrombocytopenia-3, pancreatitis-1, cortical venous thrombosis-1, coagulopathy-1, liver dysfunction-1, 6 patients required dose reduction, while in the CHOP cohort (n=20) 3 patients had neutropenic fever and 3 required dose reduction. There were no toxic deaths. Patients received prophylactic GCSF in SMILE group. The EFS and OS for 25 pts who completed treatment is 59 % (95% CI=0.29-0.80) and 70 % (95% CI=0.32-0.89), respectively at a median follow up of 15 months. There was no correlation of EFS with B symptoms, stage, IPI score or chemotherapy given (CHOP vs. SMILE), but completion of RT was a significant factor effecting survival. Conclusions: We confirm the higher CR rates and lesser on treatment progression following L-asparaginase based protocol and involved field radiation. SMILE is a feasible protocol; Toxicity with GCSF support is acceptable.