NK / T cell lymphoma

 

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NK / T-cell

Description

This is a rare subtype of lymphoma which is very aggressive.  It is usually extranodal (not in the lymph nodes) and presents in the nasal, nasopharynx, tonsular regions, though it can present elsewhere.  It is most common in Asian populations as well as some Latin American populations. The tumour cells usually show the presence of Epstein Barr Virus.

The following is a quote from the NCI's web site.



Extranodalnatural killer (NK)-/T-cell lymphoma (nasal type) is an aggressive lymphoma marked by extensive necrosis and angioinvasion, most often presenting in extranodal sites, in particular the nasal or paranasal sinus region.[53-56] Other extranodal sites include the palate, trachea, skin, and gastrointestinal tract. Hemophagocytic syndrome may occur; historically, these tumors were considered part of lethal midline granuloma.[57] In most cases, Epstein-Barr virus (EBV) genomes are detectable in the tumor cells and immunophenotyping shows CD56 positivity. Cases with blood and marrow involvement are considered NK-cell leukemia. 


Diagnosis and prognosis

As with all other forms of lymphoma a biopsy sample is necessary for a definitive diagnosis.  This type of NHL is PET avid so it will show up well on a PET scan, though the PET scan itself cannot make the diagnosis.

There is no established International Prognostic Index for NK/T-cell lymphoma as there is for other types of lymphoma. The Korean Prognostic Index (KPI) has been shown to have prognostic significance. However the IPI for Diffuse Large B-cell lymphoma has been found to be more relevant when using modern therapies.  Early stage disease has an excellent prognosis for overall survival. For late stage disease overall survival remains poor.

Treatment

Traditional treatments for other aggressive types of lymphoma have shown unsatisfactory results in NK/T-cell lymphoma and the overall survival has historically been significantly worse than similarly staged aggressive lymphomas. CHOP which is the mainstay treatment for aggressive lymphomas produces inferior results in NK/T-cell lymphoma.

Recent advances and newer chemotherapy combinations have shown significant improvements. The use of L-asparaginase in particular has had significantly better results.  Below are some articles and studies about this rare form of lymphoma.

How I treat NK/T-cell lymphomas by Eric Tse and Yok-Lam Kwong - Queen Mary Hospital Hong Kong

SMILE for natural killer (NK)/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group

Diagnosis and management of primary nasal lymphoma of T-cell or NK-cell origin.

Natural killer/natural killer-like T-cell lymphoma, CD56+, presenting in the skin: an increasingly recognized entity with an aggressive course.

 

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