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

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


Eric Tse

Clinical Professor in Haematology

Alexander Glover

Sang Eun Yoon

Won Seog Kim

Yok Lam Kwong


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.

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
Peer Reviewed Peer Reviewed
Volume 59
Issue 4
Pages 198-209
Public URL
Publisher URL


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