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


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.
Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
S J
SJ
Kim
S Y
SY
Oh
J Y
JY
Hong
M H
MH
Chang
D H
DH
Lee
J
J
Huh
Y H
YH
Ko
Y C
YC
Ahn
H-J
HJ
Kim
C
C
Suh
K
K
Kim
W S
WS
Kim
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000556:secondary*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007694:Killer Cells, Natural / Q000473:pathology*; D054391:Lymphoma, Extranodal NK-T-Cell / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000628:therapy; D009367:Neoplasm Staging; D009669:Nose Neoplasms / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate; D055815:Young Adult