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Annals of Oncology Advance Access published online on October 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdp412
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

When do we need central nervous system prophylaxis in patients with extranodal NK/T-cell lymphoma, nasal type?

S. J. Kim1, S. Y. Oh2, J. Y. Hong1, M. H. Chang1, D. H. Lee3, J. Huh4, Y. H. Ko5, Y. C. Ahn6, H.-J. Kim2, C. Suh3, K. Kim1 and W. S. Kim1,*

1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
2 Department of Internal Medicine, Dong-A University College of Medicine, Busan
3 Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
4 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
5 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
6 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

* Correspondence to: Dr W. S. Kim, Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-6548; Fax: +82-2-3410-1754; E-mail wskimsmc{at}skku.edu

Background: The incidence and risk factors of central nervous system (CNS) invasion is still unclear in extranodal natural killer (NK)/T-cell lymphoma, nasal type.

Patients and methods: We analyzed 208 patients to study the clinical features and outcomes of CNS disease in extranodal NK/T-cell lymphoma.

Results: Twelve patients (5.76%, 12/208) experienced CNS disease during treatment or follow-up period (median 11.62 months, range 0.2–123.2 months). The clinical variables associated with CNS disease were Ann Arbor stage III/IV (15.87%, P <0.001), regional lymph node involvement (10.41%, P = 0.006), group III/IV of NK/T-cell lymphoma prognostic index (NKPI; 10.20%, P = 0.003), high/high–intermediate international prognostic index (9.30%, P = 0.072) and extra-upper aerodigestive primary sites (9.75%, P = 0.008). In multivariate analysis, NKPI retained the strongest statistical power to predict CNS disease (P = 0.007, relative risk 9.289, 95% confidence interval 1.828–47.212) in extranodal NK/T-cell lymphoma.

Conclusions: Despite extranodal NK/T-cell lymphoma frequently involves paranasal sinus, a routine CNS evaluation and prophylaxis do not seem to be necessary in NKPI group I or II patients due to a very low incidence. Nevertheless, CNS prophylaxis should be considered in NKPI groups III and IV.

CNS disease, extranodal NK/T-cell lymphoma, prognosis, prophylaxis

Received for publication February 4, 2009. Revision received June 3, 2009. Revision received July 15, 2009. Accepted for publication July 17, 2009.


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