Extranodal natural killer/T-cell lymphoma: An overview on pathology and clinical management

Tse, Eric; P. Fox, Christopher P.; Glover, Alexander; Yoon, Sang Eun; Kim, Won Seog; Kwong, Yok Lam

Abstract

Natural killer (NK)/T-cell lymphomas arise mainly from NK-cells and occasionally T-cells, and are universally infected with Epstein Barr virus (EBV). They are uncommon lymphomas more prevalent in Asian and Central/South American populations. NK/T-cell lymphomas are clinically aggressive and predominantly extranodal. The most commonly involved sites are the nasal cavity, followed by non-nasal sites including the skin, gastrointestinal tract and testis. The diagnosis of extranodal NK/T-cell lymphoma is established with histological and immunohistochemical examination, together with the demonstration of EBV in the tumour cells. Staging by positron emission tomography computed tomography is essential to inform the optimal management. Plasma EBV DNA quantification should be performed as it serves as a marker for prognostication and treatment response. Survival outcomes of patients with early-stage disease are good following treatment with nonanthracycline based chemotherapy, together with sequential/concurrent radiotherapy. For advanced-stage disease, asparaginase-containing regimens are mostly used and allogeneic haematopoietic stem cell transplantation should be considered for those at high risk of relapse. Salvage chemotherapy is largely ineffective for relapsed/refractory disease, which has a grave prognosis. Novel therapeutic approaches including immune check-point blockade, EBV-specific cytotoxic T-cells, and monoclonal antibodies are being investigated to improve outcomes for those with high risk and relapsed/refractory disease.

Citation

Tse, E., P. Fox, C. P., Glover, A., Yoon, S. E., Kim, W. S., & Kwong, Y. L. (2022). Extranodal natural killer/T-cell lymphoma: An overview on pathology and clinical management. Seminars in Hematology, 59(4), 198-209. https://doi.org/10.1053/j.seminhematol.2022.10.002

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2022
• Online Publication Date: Nov 12, 2022
• Publication Date: 2022-10
• Deposit Date: Jan 11, 2023
• Publicly Available Date: Nov 1, 2023
• Journal: Seminars in Hematology
• Print ISSN: 0037-1963
• Electronic ISSN: 1532-8686
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 59
• Issue: 4
• Pages: 198-209
• DOI: https://doi.org/10.1053/j.seminhematol.2022.10.002
• Public URL: https://nottingham-repository.worktribe.com/output/15933336
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S0037196322000567?via%3Dihub