Treatment of Stage III–IV Nasal or Stage I–IV Extranasal Extranodal NK/T-Cell Lymphoma in HSCT-Eligible Patients

Extranodal NK/T-cell lymphoma presenting at advanced nasal stage (III–IV) or at any stage of extranasal disease defines a high-risk clinical scenario. For patients who are eligible for haematopoietic stem-cell transplantation (HSCT), a dedicated first-line strategy applies.

Clinical Scenario

This protocol addresses patients with stage III or IV nasal extranodal NK/T-cell lymphoma, or stage I–IV extranasal extranodal NK/T-cell lymphoma, who are eligible for haematopoietic stem-cell transplantation.

Treatment Approach

The recommended first-line approach centres on multiagent, anthracycline-free, L-asparaginase-containing chemotherapy. In eligible patients who achieve a response, consolidative haematopoietic stem-cell transplantation may be considered as part of the plan.

The complete regimen options, selection criteria, sequencing, and additional considerations are detailed in the full structured protocol.

Response Assessment

Epstein-Barr virus (EBV) DNA in peripheral blood serves as a key biomarker of treatment response and should be monitored alongside imaging-based assessment throughout therapy.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2025.01.023

A multiagent, anthracycline-free, L-asparaginase-containing regimen can be recommended for patients with stage III and IV nasal disease or stage I-IV extranasal disease (e.g. DDGP or mSMILE for HSCT-eligible and AspMetDex or P-GEMOX for HSCT-ineligible patients) [III, B].
In HSCT-eligible responding high-risk patients, consolidative auto- or allo-HSCT can be considered [III, B].
EBV DNA in peripheral blood should be monitored by quantitative PCR at baseline and during therapy as a biomarker of response, in addition to imaging-based response assessment [II, A].

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