356P - Early stage natural killer/T cell lymphoma with local tumor invasiveness treated with a uniform SMILE protocol: An institutional study from India

Date 18 December 2016
Event ESMO Asia 2016 Congress
Session Poster lunch
Topics Cytotoxic agents
Presenter Vineet Gupta
Citation Annals of Oncology (2016) 27 (suppl_9): ix104-ix111. 10.1093/annonc/mdw586
Authors V.G. Gupta1, A. Gogia1, P. Mehta1, L. Kumar1, A. Sharma1, S. Bakhshi1, S. Thulkar2, M.C. Sharma3, S. Mallick3, R.K. Sahoo1, P. Malik1
  • 1Medical Oncology, Dr. BRA Institute Rotary Cancer Hospital (AIIMS), 110029 - New Delhi/IN
  • 2Radiodiagnosis, Dr. BRA Institute Rotary Cancer Hospital (AIIMS), 110029 - New Delhi/IN
  • 3Pathology, All India Institute of Medical Sciences, 110029 - New Delhi/IN



Local Tumor Invasiveness (LTI) is among the strongest prognostic factors in Early Stage Nasal Natural Killer/T Cell Lymphoma (ES-NNKTCL), with very poor outcomes. Standard therapy is concurrent or sequential chemotherapy and radiotherapy (RT). SMILE (Dexamethasone, Methotrexate, Ifosfamide, L-asparaginase and Etoposide) is an intensive, highly active protocol in this disease. No prior study has explored SMILE with RT specifically for ES-NNKTCL with LTI.


Between 2011 and 2015, all patients with ES-NNKTCL with LTI at our center were treated with a uniform protocol of SMILE for 6 cycles with sandwiched RT (45-50 Gray). LTI was defined as bony invasion/destruction or involvement of the skin. Records of these patients were retrospectively reviewed.


Sixteen patients (62% male) were identified with median age 31 years (range 19-55). Eleven (69%) were stage I and 5 (31%) were stage II. Facial skin involvement (56%), palatal invasion (69%), or orbital extension (56%) were present in the majority. 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. International prognostic index was 0, 1, and 2 in 56%, 19% and 25% respectively. Korean prognostic score was 0, 1, 2, and 3 in 19%, 38%, 31% and 12% respectively. All patients received 5-6 cycles (Five patients received 5 cycles, the rest received 6 cycles) barring those who progressed on therapy. RT was delivered after a mean 4 ± 1 cycles. At a median follow up of 14.5 months (range 2-63), 2/16 patients are still on therapy. Among the remaining 14, two patients (14%) relapsed while on therapy. Rest all achieved complete remission at the end of the treatment (86%). For the entire cohort, one year progression-free survival was 78% and overall survival was 93%. Grade III-IV toxicity was seen in 81%, most commonly neutropenia (69%), anemia (38%) and thromobocytopenia (31%). Neutropenic fever was seen in 25% despite growth factor prophylaxis. Six patients (38%) required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related deaths occurred.


SMILE with RT is a toxic but tolerable protocol for ES-NNKTCL with LTI with high efficacy. Prospective studies are warranted.

Clinical trial indentification

Legal entity responsible for the study





All authors have declared no conflicts of interest.