Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India
Context: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2018-01-01
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| Series: | Indian Journal of Medical and Paediatric Oncology |
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| Online Access: | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2018;volume=39;issue=1;spage=67;epage=72;aulast=Gupta |
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| author | Vineet G Gupta Ajay Gogia Lalit Kumar Atul Sharma Sameer Bakhshi Mehar C Sharma Saumyaranjan Mallick Ahitagni Biswas Prashant Mehta Sanjay Thulkar Ranjit K Sahoo Rakesh Kumar |
| author_facet | Vineet G Gupta Ajay Gogia Lalit Kumar Atul Sharma Sameer Bakhshi Mehar C Sharma Saumyaranjan Mallick Ahitagni Biswas Prashant Mehta Sanjay Thulkar Ranjit K Sahoo Rakesh Kumar |
| author_sort | Vineet G Gupta |
| collection | DOAJ |
| description | Context: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active protocol mainly studied in advanced/recurrent disease. No prior study has utilized this protocol in high-risk ES-NKTCL. Methods: Between 2011 and 2016, all patients with ES-NKTCL with LTI at presentation were uniformly treated at our institute with a combination of SMILE chemotherapy for 5–6 cycles, and involved-field radiotherapy (IFRT). Records of these patients were retrospectively reviewed. Results: Sixteen patients were identified, 69% stage IE and 31% stage IIE. The majority of patients had B-symptoms (75%), paranasal sinus (PNS) invasion (81%), facial skin invasion (56%), palatal perforation (69%), or orbital extension (56%). 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. All patients received the entire planned 5–6 cycles. IFRT was delivered after a mean 4 cycles. Complete remission was achieved in 13/15 (87%) patients. At a median follow up of 18.5 months, 1-year progression-free survival and overall survival was 84% and 94%, respectively. Grade 3–4 toxicity was seen in 81%, most commonly neutropenia (75%), anemia (44%), and thromobocytopenia (31%). Six patients required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related mortality was noted. Conclusion: SMILE with RT is a toxic but tolerable protocol for ES-NKTCL with LTI with high efficacy. Prospective studies are warranted. |
| format | Article |
| id | doaj-art-6c10004f6e6c49dda2e0751de53bb65f |
| institution | DOAJ |
| issn | 0971-5851 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Medical and Paediatric Oncology |
| spelling | doaj-art-6c10004f6e6c49dda2e0751de53bb65f2025-08-20T03:06:10ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Medical and Paediatric Oncology0971-58512018-01-01391677210.4103/ijmpo.ijmpo_60_17Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from IndiaVineet G GuptaAjay GogiaLalit KumarAtul SharmaSameer BakhshiMehar C SharmaSaumyaranjan MallickAhitagni BiswasPrashant MehtaSanjay ThulkarRanjit K SahooRakesh KumarContext: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active protocol mainly studied in advanced/recurrent disease. No prior study has utilized this protocol in high-risk ES-NKTCL. Methods: Between 2011 and 2016, all patients with ES-NKTCL with LTI at presentation were uniformly treated at our institute with a combination of SMILE chemotherapy for 5–6 cycles, and involved-field radiotherapy (IFRT). Records of these patients were retrospectively reviewed. Results: Sixteen patients were identified, 69% stage IE and 31% stage IIE. The majority of patients had B-symptoms (75%), paranasal sinus (PNS) invasion (81%), facial skin invasion (56%), palatal perforation (69%), or orbital extension (56%). 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. All patients received the entire planned 5–6 cycles. IFRT was delivered after a mean 4 cycles. Complete remission was achieved in 13/15 (87%) patients. At a median follow up of 18.5 months, 1-year progression-free survival and overall survival was 84% and 94%, respectively. Grade 3–4 toxicity was seen in 81%, most commonly neutropenia (75%), anemia (44%), and thromobocytopenia (31%). Six patients required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related mortality was noted. Conclusion: SMILE with RT is a toxic but tolerable protocol for ES-NKTCL with LTI with high efficacy. Prospective studies are warranted.http://www.ijmpo.org/article.asp?issn=0971-5851;year=2018;volume=39;issue=1;spage=67;epage=72;aulast=GuptaAsparaginasechemotherapylymphomamethotrexatenatural killer cells |
| spellingShingle | Vineet G Gupta Ajay Gogia Lalit Kumar Atul Sharma Sameer Bakhshi Mehar C Sharma Saumyaranjan Mallick Ahitagni Biswas Prashant Mehta Sanjay Thulkar Ranjit K Sahoo Rakesh Kumar Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India Indian Journal of Medical and Paediatric Oncology Asparaginase chemotherapy lymphoma methotrexate natural killer cells |
| title | Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India |
| title_full | Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India |
| title_fullStr | Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India |
| title_full_unstemmed | Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India |
| title_short | Combined modality treatment with “dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide” chemotherapy and involved field radiotherapy for early stage natural Killer/T cell lymphoma with local tumor invasiveness: A single-institution study from India |
| title_sort | combined modality treatment with dexamethasone methotrexate ifosfamide l asparaginase and etoposide chemotherapy and involved field radiotherapy for early stage natural killer t cell lymphoma with local tumor invasiveness a single institution study from india |
| topic | Asparaginase chemotherapy lymphoma methotrexate natural killer cells |
| url | http://www.ijmpo.org/article.asp?issn=0971-5851;year=2018;volume=39;issue=1;spage=67;epage=72;aulast=Gupta |
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