High-dose chemotherapy with hematopoietic stem cell transplantation is effective for nasal and nasal-type CD56+ natural killer cell lymphomas

• Published in: Leukemia & lymphoma 2001-11, Vol.42 (6), p.1297-1303
• Main Authors: Takenaka, K, Shinagawa, K, Maeda, Y, Makita, M, Kozuka, T, Ashiba, A, Yamamoto, K, Fujii, N, Nawa, Y, Hiramatsu, Y, Sunami, K, Ishimaru, F, Yoshimo, T, Kiura, K, Harada, M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; CD56 Antigen - analysis; Combined Modality Therapy; Female; Hematopoietic Stem Cell Transplantation; Humans; Killer Cells, Natural; Lymphoma, T-Cell - mortality; Lymphoma, T-Cell - therapy; Male; Middle Aged; Nose Neoplasms - mortality; Nose Neoplasms - therapy; Salvage Therapy
• ISSN: 1042-8194; 1029-2403
• DOI: 10.1080/10428190127500

CD56+ natural killer (NK) cell lymphomas occur frequently in the nasal and nasopharyngeal regions and carry a poor prognosis. We have studied seven cases with NK-cell lymphomas. These lymphomas showed the following immunophenotype: CD56+, CD2+, sCD3- and Epstein-Barr virus-encoded small RNAs (EBERs)+. Six patients had localized (stage I or II) disease involving the nasopharyngeal region, while one had stage III disease. One patient with stage I disease achieved a complete remission (CR) after treatment with involved-field irradiation, but subsequently relapsed and died. The remaining six patients received combination chemotherapy as primary treatment: five patients with localized stage I or II disease and one patient with advanced stage III disease. Responses to initial chemotherapy were generally poor. These six patients received a variety of salvage chemotherapy regimens, but never achieved a CR. Subsequently, four of six patients showed a highly aggressive clinical course and died of disseminated disease within 1 year from the diagnosis. Three of six patients received high-dose chemotherapy supported by syngeneic, autologous or allogeneic peripheral blood stem cell transplantation. Two of the three transplant patients achieved a CR and are now surviving in continuous CR. Our clinical experience suggests that myeloablative high-dose chemotherapy and bone marrow rescue by hematopoietic stem cell transplantation may be an effective salvage treatment modality for refractory NK-cell lymphomas and could be considered as a part of the initial therapy for these patients.