scholarly journals Nutrition-Incorporated Pink-E Predicts Survival of Extranodal NK/T-Cell Lymphoma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2476-2476
Author(s):  
Tiange Lu ◽  
Xiangxiang Zhou ◽  
Yiqing Cai ◽  
Shunfeng Hu ◽  
Yujie Jiang ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Nutritional Status ◽  
Natural Killer ◽  
Validation Cohort ◽  
Cell Lymphoma ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Conut Score

Abstract Introduction: Patients with aggressive lymphomas are at high risk of losing body resources, resulting in malnutrition, immunodeficiency, impaired life quality and inferior outcomes. Nutritional status is closely associated with the development and treatment arrangements of malignancies, but often neglected in the prognostic assessment. Thus, this study aimed to explore the prognostic significance of nutrition-related parameters in extranodal NK/T-cell lymphoma (ENKTL), an aggressive lymphoma with dismal outcomes. Methods: We retrospectively analyzed patients diagnosed with ENKTL between 2011 and 2020 from Shandong Provincial Hospital and Affiliated Hospital of Qingdao University. The observation endpoints were overall survival (OS) and progression-free survival (PFS). Univariate (UVA) and multivariate (MVA) Cox regression analyses were conducted to examine the significance of variables at diagnosis on OS and PFS. A reformative nutrition assessment-incorporated score system was constructed based on the MVA results. Its performance was tested in the training and validation cohort from multiple aspects, including calibration, discrimination and clinical utility. Results: A total of 160 patients with a median age of 50 (39, 58.75) years and male predominance (67.5%) were included. The prognostic significance of two emerging nutritional indexes, prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score, was assessed. UVA analysis showed PNI was a meaningful marker to OS (HR 2.275, P=0.014) but not to PFS (HR 1.653, P=0.089) while CONUT score was a significant predictor not only to OS (HR 29.385, P＜0.001) but to PFS (HR 12.516, P＜0.001). MVA analysis further verified that CONUT score could independently predict OS (HR 10.247, P=0.001) and PFS (HR 5.587, P=0.001) in addition to prognostic index of natural killer lymphoma plus EBV (PINK-E), another independent marker (PINK-E=2, HR 3.842, P=0.034, PINK-E=3/4/5, HR 9.185, P=0.006 for OS; PINK-E=2, HR 2.308, P=0.06, PINK-E=3/4/5, HR 4.535, P=0.004 for PFS) (Figure 1). Based on this finding, a modified prognosis scoring tool, CONUT-PINK-E, was developed from the training cohort (TC) and tested in the independent external validation cohort (VC). The novel model contains six factors, age≥60 years old, Ann Arbor III/IV stage, distant lymph node involvement, non-nasal type, detectable EBV-DNA in blood and CONUT score≥5 (moderate and severe malnutrition). CONUT-PINK-E differentiated patients into low-, intermediate- and high-risk grades according to the imparities of survival probability revealed by Kaplan-Meier curves. Significant survival differences existed among three risk grades that the median OS was 74, 36, 5 months and median PFS was 31, 14, 4 months, respectively, for the low-, intermediate-, high-risk group (P＜0.001) in TC and the corresponding data were 72, 26, 7 months and 35, 14, 4 months in VC (P＜0.001, Figure 2). Subsequently, the superiority of CONUT-PINK-E was examined by comparison with international prognostic index (IPI), Korean Prognostic Index (KPI), Prognostic index of natural killer lymphoma (PINK) and PINK-E. The 1- to 5-year time-dependent areas under receiver operating characteristic curve (AUCs) hinted that CONUT-PINK-E (TC: 0.832-0.961, VC: 0.773-0.937) possessed higher discrimination than IPI (TC: 0.710-0.785, P<0.001; VC: 0.646-0.840, P<0.001), KPI (TC: 0.659-0.826, P<0.001; VC: 0.623-0.691, P<0.001), PINK (TC: 0.802-0.865, P<0.001; VC: 0.663-0.842, P<0.001) and PINK-E(TC: 0.815-0.902, P<0.001; VC: 0.741-0.894, P<0.001) (Figure 3A, 3B). Decision curve analysis plainly showed CONUT-PINK-E brought higher clinical net benefits than IPI, KPI, PINK and PINK-E in forecasting OS and PFS of ENKTL (Figure 3C, 3D). In addition, net reclassification index (NRI) and integrated discrimination improvement (IDI) conformably demonstrated that CONUT-PINK-E achieved significant improvements than the prior stratification tools. Conclusion: This is the first time that CONUT score was recognized capable of acting as an independent prognostic marker in newly-diagnosed ENKTL patients. More importantly, the first risk score covering nutritional status assessment for ENKTL, CONUT-PINK-E, was proposed and presented striking performance. The newly-built model could deliver vital reference to the risk stratification and comprehensive managements of ENKTL patients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Novel and simple prognostic index for nasal natural killer/T-cell lymphoma

Head & Neck ◽  
2013 ◽  
Vol 36 (4) ◽  
pp. 551-556 ◽  
Author(s):  
Hiroyuki Hanakawa ◽  
Yorihisa Orita ◽  
Yasuharu Sato ◽  
Soshi Takao ◽  
Hidenori Marunaka ◽  
...  
Keyword(s):  
T Cell ◽  
Natural Killer ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Natural Killer T Cell ◽  
Killer T Cell ◽  
Natural Killer T

scholarly journals High C-Reactive Protein to Albumin Ratio Predicts Inferior Clinical Outcomes in Extranodal Natural Killer T-Cell Lymphoma

Dose-Response ◽  
2020 ◽  
Vol 18 (2) ◽  
pp. 155932582091782
Author(s):  
Quan-shu Di ◽  
Tao Xu ◽  
Ying Song ◽  
Zhi-gang Zuo ◽  
Feng-jun Cao ◽  
...  
Keyword(s):  
T Cell ◽  
Natural Killer ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Natural Killer T Cell ◽  
Reactive Protein ◽  
Killer T Cell ◽  
Natural Killer T

Objective: The prognostic value of C-reactive protein to albumin ratio (CAR) has been identified in several cancers but not in extranodal natural killer T-cell lymphoma (ENKTL) as yet. We aimed to evaluate the prognostic value of CAR in ENKTL. Methods: A retrospective study with 246 patients with ENKTL was performed to determine the prognostic value of pretreatment CAR and examine the prognostic performance of CAR incorporating with International Prognostic Index (IPI) or natural killer/T-cell lymphoma prognostic index (NKPI) by nomogram. Results: The Cox regression analyses showed that high CAR (>0.3) independently predicted unfavorable progression-free survival (PFS, P = .011) and overall survival (OS, P = .012). In the stratification analysis, the CAR was able to separate patients into different prognoses regarding both OS and PFS in Ann Arbor stage I+II as well as III+IV, IPI score 0 to 1, and NKPI score 1 to 2 subgroups (all P < .05). Additionally, the predictive accuracy of the IPI-based nomogram incorporating CAR, albumin to globulin ratio (AGR), and IPI for OS and PFS appeared to be lower than the NKPI-based nomogram incorporating CAR, age, AGR, extranodal site, and NKPI. Conclusion: Pretreatment CAR is a simple and easily accessible parameter for independently predicting OS and PFS in patients with ENKTL.

A proposal for a prognostic index for non-nasal type natural killer/T cell lymphoma after asparaginase-based treatment

2020 ◽  
Vol 99 (12) ◽  
pp. 2811-2819
Author(s):  
Zegeng Chen ◽  
Xiaojie Fang ◽  
He Huang ◽  
Zhao Wang ◽  
Huangming Hong ◽  
...  
Keyword(s):  
T Cell ◽  
Natural Killer ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Nasal Type ◽  
Natural Killer T Cell ◽  
Killer T Cell ◽  
Natural Killer T

Clinical, Pathological, and Prognostic Characteristics Of Mature Nodal Or Extranodal T-Cell and NK-Cell Non-Hodgkin´s Lymphoma (NHL) In a Single Mexican Institution

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1763-1763
Author(s):  
Gladys P Agreda-Vásquez ◽  
Erick Crespo-Solis ◽  
Gustavo J Ramos-Blas ◽  
Cesar Lara-Torres ◽  
Carmen Lome-Maldonado ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
T Cell ◽  
High Risk ◽  
Nk Cell ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Number Of Patients ◽  
Who 2008

Abstract Background Mature nodal or extranodal T-cell and NK-cell NHL are a rare and heterogeneous group of NHL with aggressive behavior and poor clinical outcome. Their incidence varies according to geographical region and racial characteristics. Mexico is included in those countries known to have a high incidence of extranodal T/NK-cell lymphoma, type nasal (NKTCL). Objective To evaluate the outcome and prognosis of patients with mature nodal or extranodal T-cell or NK-cell NHL in a single institution in Mexico City. Methods Clinicopathological characteristic, treatment, outcome, and prognosis of patients admitted to our institution between August, 1991 and December 2009 were analyzed. Prognostic Index T-cell (PIT) was used in all subtypes of lymphomas except in NKTCL subtype. All tissue biopsies and immunophenotypic markers were reviewed by an expert hematopathologist and reclassified according to the WHO 2008 classification. Univariate analysis using log-rank test was used to determine the correlation between clinical features and overall survival (OS). Multivariate analysis using Cox proportional hazard models were performed. A p value < 0.05 was considered significant. Results A total of 67 patients were analyzed. Median age was 37 years. B symptoms were presented in 83.6%, 74.6% had at least one site with extranodal disease, 73.1% advanced clinic stage, 32.8% high risk by International Prognostic Index (IPI) and 47.5% high risk by PIT. According to WHO 2008 classification the most common subtype was peripheral T-cell lymphoma not otherwise (PTCL NOS) specified in 38 patients (56.7 %), angioimmunoblastic T-cell lymphoma (AITL) and NKTCL were the second most common subtypes with 8 cases in each group (11.9 %), anaplastic large cell lymphoma (ALCL) kinase-positive (ALK-positive) was identified in 3 patients (4.5 %), ALCL ALK-negative in 2 cases (3.0 %), lymphoblastic lymphoma and subcutaneous panniculitis-like T-cell lymphoma (SPTCL) with 3 patients in each group (4.5 %), hepatosplenic T-cell lymphoma (HSTL) and aggressive NK-cell leukemia with one case in each group (1.5 %). CHOP-like therapy was used in 71.6 % of patients. Nine percent of patients did not receive treatment. The response was evaluated in 53 patients in whom overall response was 71.7 % with 44.8 % achieving complete remission (CR). Median OS was 2760 days (CI 95 % 1153.145-4366.855). Histopathology subtype did not predict OS. Both prognostic scores, IPI and PIT, were able to identify 4 groups of patients with different outcomes. The analysis failed to demonstrate any advantage of adding etoposide to the chemotherapy schedule. Multivariate analysis showed that, IPI, PIT, and CR were predictive for OS (Table 1). Conclusion Previous publications in Mexican population, with larger number of patients included, were particularly focus on clinical characteristics and prognosis of NKTCL. Our series provides data of mature nodal or extranodal T-cell and NK-cell NHL in Mexico. The current study confirms the poor prognosis of aggressive forms of mature nodal or extranodal T-cell and NK-cell NHL regardless of the chemotherapy schedule employed. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prognostic Value of 25‑Hydroxy Vitamin D in Extranodal NK/T Cell Lymphoma

2020 ◽  
Author(s):  
Jin Mao ◽  
Hua Yin ◽  
Li Wang ◽  
Jia-Zhu Wu ◽  
Yi Xia ◽  
...  
Keyword(s):  
Vitamin D ◽  
T Cell ◽  
Vitamin D Deficiency ◽  
Prognostic Value ◽  
Cell Lymphoma ◽  
Prognostic Significance ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
25 Hydroxy Vitamin D ◽  
Nk T Cell

Abstract Background 25-hydroxy vitamin D [25-(OH)D] is widely used to determine vitamin D status in clinic. The aim of our study was to evaluate the prognostic value of 25-(OH)D in extranodal NK/T cell lymphoma (ENKTL). Materials and Methods Ninety-three ENKTL patients with available serum 25-(OH)D values were enrolled in our study. Vitamin D deficiency is defined as a 25-(OH)D below 50 nmol/L. Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). Subgroup analyses were performed to determine the applicable subgroups. Receiver operator characteristic (ROC) curves were plotted to estimate the accuracy of PINK-E (prognostic index of natural killer lymphoma added with Epstein-Barr virus-DNA status) and 25-(OH)D deficiency in ENKTL risk-stratification. Results Our results suggested that vitamin D deficiency was an independent inferior prognostic factor for both PFS [hazard ratio (HR), 2.869; 95% confidence interval (CI), 1.540 to 5.346; P = 0.003] and OS (HR, 3.204; 95%CI, 1.559 to 6.583; P = 0.006) in ENKTL patients with age ≤ 60, ECOG PS ≤ 1, stage III‒IV and PINK-E score ≥ 3. Additionally, we demonstrated that adding 25-(OH)D deficiency to PINK-E score system indeed has a superior prognostic significance than PINK-E alone for PFS [AUC: 0.796 (95% CI: 0.699 to 0.872) vs. 0.759 (95% CI: 0.659 to 0.841), P = 0.020] and OS [AUC: 0.755 (95% CI: 0.655 to 0.838) vs. 0.721 (95% CI: 0.618 to 0.809), P = 0.040]. Conclusion In conclusion, our study proved that 25-(OH)D deficiency was associated with inferior survival outcomes of ENKTL patients.

scholarly journals Prognostic Value of NCCN-IPI and Interim PET/CT Based on Visual Assessment in the Treatment of Peripheral T Cell Lymphomas

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1822-1822
Author(s):  
Seo-Yeon Ahn ◽  
Ho-Young Yhim ◽  
Young Rok Do ◽  
Sung-Hoon Jung ◽  
Jae-Sook Ahn ◽  
...  
Keyword(s):  
Overall Survival ◽  
T Cell ◽  
High Risk ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
Visual Assessment ◽  
T Cell Lymphoma ◽  
Peripheral T Cell Lymphoma ◽  
Interim Pet ◽  
Pet Ct

Abstract Background It has been well known that peripheral T cell lymphoma (PTCL) has undergone poor prognosis compared with other non-Hodgkin lymphomas (NHL). Although the National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI) has been proposed to determining prognosis for patients with diffuse large B-cell lymphoma (DLBCL) at 2014, there is no study examines whether NCCN-IPI could apply to the T-cell NHLs. In addition, a few studies suggest prognostic utility of interim PET/CT in PTCL, but the role of interim PET/CT is not clear. Purpose We evaluate the predictive efficacy of the NCCN-IPI and interim PET/CT based on visual assessment in patients with newly diagnosed PTCLs. Methods This study included 153 patients with de novo peripheral PTCLs, diagnosed from January 2010 to August 2015. The NCCN-IPI was calculated as following the original references. Survival outcomes were compared with a matched result of IPI and/or Prognostic Index for peripheral T cell lymphoma, unspecified (PIT). Visual assessment of interim PET/CT based on Deauville five point scales was performed at the time of diagnosis, mid-treatment and completion of CHOP/CHOP-like or other non-anthracycline chemotherapy. Results The subtypes of PTCLs included PTCL, not otherwise specified (PTCL-NOS) (26%), angioimmunoblastic T cell lymphoma (20%), anaplastic large cell lymphoma (13%), extranodal NK/T cell lymphoma, nasal type (35%), and the others (6%). The NCCN-IPI showed better risk-based prognostic discrimination than IPI and PIT, especially between high-intermediate and high risk subgroups (3-year overall survival 40% vs. 27% vs. 26% among the high-intermediate risk group, respectively; 3-year overall survival 15% vs. 33% vs. 32% among the high risk group, respectively) with a median follow-up of 25.1 months (Figure 1). The absolute difference of survival rates between the low and high risk groups was 75% based on the NCCN-IPI stratification compared with 45% on the IPI stratification or 54% on the PIT stratification, respectively. When divided into two histologic subgroups (nodal vs. extra-nodal type), the NCCN-IPI showed considerable discriminatory capacity in both histologic groups. However, the IPI or PIT classification could not have discrimination in extra-nodal PTCLs. The interim PET-CT was significantly predicting for progression free survival in all PTCL patients, however, it also showed no predictive value in the patients with extranodal PTCLs, especially NK/T cell lymphoma. Conclusions The NCCN-IPI is a powerful prognostic model in PTCLs predicting overall survival among high-intermediate and high risk patients. Also, interim PET/CT response based on visual assessment could be a valuable prediction tool in nodal PTCLs, however, it should be carefully interpreted in the treatment of extranodal subtypes. Disclosures No relevant conflicts of interest to declare.

scholarly journals EGR1 as a potential marker of prognosis in extranodal NK/T-cell lymphoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ji Yun Lee ◽  
Joo Hyun Kim ◽  
Heejin Bang ◽  
Junhun Cho ◽  
Young Hyeh Ko ◽  
...  
Keyword(s):  
Gene Expression ◽  
T Cell ◽  
Natural Killer ◽  
Target Genes ◽  
Prognostic Markers ◽  
Cell Lymphoma ◽  
Prognostic Index ◽  
T Cell Lymphoma ◽  
Good Survival ◽  
Expression Levels

AbstractExtranodal natural killer T-cell lymphoma (ENKTL) is an aggressive malignancy with a dismal prognosis. In the present study, gene expression profiling was performed to provide more information on ENKTL molecular signature and offer a rationale for further investigation of prognostic markers in ENKTL. NanoString nCounter Analysis encompassing 133 target genes was used to compare gene expression levels of 43 ENKTL tumor samples. The majority of the patients were under 60 years of age (79.1%); 32 (74.4%) patients had nasal type ENKTL and 23 patients (53.5%) had intermediate/high risk ENKTL based on the prognostic index for natural killer cell lymphoma (PINK). The median follow-up was 15.9 months and the median overall survival (OS) was 16.1 months (95% CI 13.0–69.8). EGR1 upregulation was consistently identified in the localized stage with a low risk of prognostic index based on the PINK. Among the six significantly relevant genes for EGR1 expression, high expression levels of genes, including CD59, GAS1, CXCR7, and RAMP3, were associated with a good survival prognosis. The in vitro test showed EGR1 modulated the transcriptional activity of the target genes including CD59, GAS1, CXCR7, and RAMP3. Downregulation of EGR1 and its target genes significantly inhibited apoptosis and decreased chemosensitivity and attenuated radiation-induced apoptosis. The findings showed EGR1 may be a candidate for prognostic markers in ENKTL. Considerable additional characterization may be necessary to fully understand EGR1.

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