Refractory NK/T Cell Lymphoma Treated with Bortezomib+Chemotherapy and APBSCT.

NK/T cell lymphoma is a rare disease, but usually shows a highly aggressive clinical course and its prognosis is poor due to the stumbling block in early diagnosis and effective management. Until present, there are no consensus treatments especially for recurrent patients. Bortezomib, and other new drugs are subject to active investigation, although only limited preliminary information is available. Here, 3 cases of refractory disseminated NK/T cell lymphoma were treated with Bortezomib plus high dose chemotherapy as salvage therapy.

From 2008–2010, 3 cases of refractory NK/T cell lymphoma, 2 males, 1 female, aged from 26–35, PS 0–1 were enrolled. Former treatments included at least 2–9 months of chemotherapy (CHOP or CHOP like) and local radiotherapy. The stage of patients was III in 2, IV in 1. IPI scores were all in high risk.

3 patients received high dose chemotherapy combined with bortezomib as re-induction treatment. 2 patients received hyperCVAD as induction therapy with bortezomib given 1.3mg/m2 on d2, 5, 9 and 12. 1 patient received bortezomib and SMILE protocol, included bortezomib 1.3 mg/m2 on days1, 4, 8, 11, dexamethasone 20 mg twice a day on days 1 through 4, etoposide 100 mg/m2 on days 1 through 3, ifosphamide 1.0 g/m2 on days 1 through 5, methotrexate 30 mg/m2 on days 4, 11, L-asparaginase 6000U/m2 on days 7, 9, 11, 13, 15. All 3 patients had response to the treatment. HyperCVAD, HDAC+MTX and SMILE protocol combined with bortezomib were also given to the patients as consolidation therapy for 1–4 courses. After 2 course of treatment, 1 patient got CR, 2 got PR. Then ASCT was performed. Condition protocol was SEAM+Bz1.3 mg/m2 on days-4, -1. At a median follow-up for 15 months, the median duration of PFS was 12 months. No PN was found in all patients. SAE were neutropenia and thrombocytopenia grade 4, mucositis grade 3, increase AST grade 2 in 3 patients and HZV infection in 1.

Bortezomib combined with high dose therapy may be effective salvage therapy in some refractory disseminated NK/T cell lymphoma, especially in young adults. More cases need to be carefully investigated to explore the effect and side effect in bortezomib plus high dose therapy in this special disease.

No relevant conflicts of interest to declare.