This protocol addresses patients with stage III–IV nasal extranodal NK/T-cell lymphoma, or stage I–IV extranasal extranodal NK/T-cell lymphoma, who remain eligible for haematopoietic stem-cell transplantation (HSCT) and require a next treatment step.
Prior therapy: Multiagent, anthracycline-free, L-asparaginase-containing chemotherapy — DDGP or mSMILE — with or without involved-site radiotherapy; or alternatively sintilimab combined with an L-asparaginase-containing regimen.
Goal not reached: Reduction and clearance of Epstein-Barr virus (EBV) DNA in peripheral blood — the key biomarker of treatment response — was not achieved, triggering escalation to this salvage protocol.
Salvage therapy in this setting may involve an anti-PD-1 antibody, used alone or in combination, with further consolidation options for patients who respond.
The complete regimen options, sequencing, and transplant eligibility criteria are detailed in the full structured protocol.
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].
If available, an anti-PD-1 antibody such as pembrolizumab (not EMA or FDA approved) or nivolumab (not EMA or FDA approved) can be considered as monotherapy or in combination with gemcitabine and/or L-asparaginase or crisantaspase [III, B].
As an alternative, platinum-based regimens (e.g. GDP) can be considered [III, B].
For HSCT-eligible patients responding to salvage therapy, HSCT (preferably allo-HSCT if not used in first line) may be considered [III, C].
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