This protocol covers patients with stage III–IV nasal extranodal NK/T-cell lymphoma, or with stage I–IV extranasal extranodal NK/T-cell lymphoma, who are not eligible for haematopoietic stem-cell transplantation (HSCT). Ineligibility for transplant defines a specific treatment pathway distinct from the transplant-eligible population in this aggressive lymphoma subtype.
Evidence supports a multiagent, anthracycline-free chemotherapy backbone centred on L-asparaginase, with immunotherapy combinations representing an additional option in this setting — the complete regimen selection and clinical algorithm are available in the full protocol.
Treatment response is tracked using EBV DNA levels in peripheral blood as a validated biomarker, alongside imaging-based assessment.
Full regimen details, sequencing, and management of specific clinical circumstances are not shown here.
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].
First-line treatment with anti-PD-1 antibodies such as sintilimab [not European Medicines Agency (EMA) or Food and Drug Administration (FDA) approved] in combination with L-asparaginase-containing regimens (e.g. P-GEMOX) should also be considered in patients with stage III and IV nasal disease or stage I-IV extranasal disease [III, A].
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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