Extranodal Natural killerTcell Lymphoma of Nasal Cavity: The Toronto Experience

1
Extranodal Natural killer/T-cell Lymphoma of
Nasal Cavity The Toronto Experience

• Richard Tsang
• Mary Gospodarowicz
• Melania Pintilie
• Bruce Patterson
• Woody Wells
• Michael Crump
• on behalf of Lymphoma Group
• Princess Margaret Hospital
• University of Toronto

2
Extranodal NK/T-cell Lymphoma, Nasal type

• Background
• Characterized by CD56 , EBV
• Historically known as Lethal Midline Granuloma -
  treated with RT
• relapse systemically/locally
• Reported series from south-east Asia, central
  America
• Very rare in Western Countries

3
Extranodal NK/T-cell Lymphoma, Nasal type

• Objectives
• Retrospective review of 22 patients from PMH,
  Toronto
• treatment outcome
• Patterns of failure
• Does ethnic origin influence the presentation of
  the disease and outcome?

4
Extranodal NK/T-cell Lymphoma, Nasal type

• Median age 52 yrs (range 23-89)
• F / M 8 / 14
• Caucasian 11, Asian 10, Aboriginal 1
• All had nasal location of disease
• Treatment policy
• Combined modality therapy
• ASCT since 2000 for those eligible

5
Extranodal NK/T-cell Lymphoma, Nasal type

• Stage I E 16
• Stage II E 2
• Stage IV 4
• Chemotherapy (n 20)
• CHOP 17 (85)
• VACOPB 3 (15)

6
Extranodal NK/T-cell Lymphoma, Nasal type
7
Extranodal NK/T-cell Lymphoma, Nasal type, RT
details (N 21)

• Total Dose
• lt 35 Gy 2 (10)
• 35 - 39 Gy 6 (29)
• 40 Gy 4 (19)
• 41 45 Gy 6 (29)
• 46 50 Gy 3 (14)

Both pts died before completing RT 1.33 Gy x
30 F bid over 3 weeks
8
Extranodal NK/T-cell Lymphoma, Nasal type
Treatment Summary
NR no response C Caucasian A Asian
9
Extranodal NK/T-cell Lymphoma, Nasal type

• CT treated patients (n 20)
• Overall response 7/20 35
• Responders (n 7)
• NED 5
• Non-responders (n 13)
• NED 2
• Median survival 6.8 months
• Salvage RT in 12 (CR 42, PR 17)

10
Extranodal NK/T-cell Lymphoma, Nasal type

• Dominant sites of failure in 13 pts not
  responding to CT
• Local 8 (62)
• Cervical LN 2 (15)
• Other EN sites 7 (54)
• CNS 3 (23)

11
Extranodal NK/T-cell Lymphoma, Nasal type

• How applicable is ASCT?
• Since 2000, among 11 pts referred
• 4 received ASCT (3 in CR, 1 for sensitive
  relapse)
• 2 not eligible (age over 70)
• 5 resistant to salvage CT

12
Extranodal NK/T-cell Lymphoma, Nasal type -
Survival
13
Extranodal NK/T-cell Lymphoma, Nasal type DFS
by Ethnicity
14
Extranodal NK/T-cell Lymphoma, Nasal type

• Conclusions
• Conventional CMT is inadequate therapy for
  NK/T-cell lymphoma
• More intensive treatment approaches should be
  investigated (? Concurrent CT/RT)
• No significant differences in presentation and
  treatment outcome between Caucasian and Asian
  patients
• Local failure common, escalation of RT dose is
  required