Researchers have developed 2 prognostic models for natural killer lymphoma that can be used to develop risk-adapted treatment strategies for patients with extranodal natural killer T-cell lymphoma (ENKTL). The models are specifically for patients being treated without anthracycline-based therapy.1

Because the clinical outcomes of patients with ENKTL has improved tremendously due to novel treatment approaches with non-anthracycline-based chemotherapy and frontline use of concurrent chemoradiotherapy or radiotherapy, researchers sought to develop a new prognostic model based on the outcomes in this contemporary era.

For the retrospective study, researchers analyzed data from 527 patients with newly diagnosed, previously untreated ENKTL who received non-anthracycline-based chemotherapy with or without upfront concurrent chemoradiotherapy or radiotherapy with curative intent. Patients were treated at 38 hospitals in 11 countries.

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Results showed that age greater than 60 years, stage 3 or 4 disease, distant lymph-node involvement, and non-nasal type disease were significantly associated with progression-free and overall survival.

Researchers then used these data to develop the prognostic index of natural killer lymphoma (PINK). In this model, patients are stratified as being low-risk (no risk factors), intermediate-risk (1 risk factor), or high-risk (≥ 2 risk factors), which were associated with a 3-year overall survival rate of 81% (95% CI, 75 – 86), 62% (95% CI, 55 – 70), and 25% (95% CI, 20 – 34), respectively.

A second prognostic index, PINK-E, was developed using data from 328 patients with data for Epstein-Barr virus DNA. Researchers found that a detectable viral DNA titre was independently associated with overall survival.

For this model, patients were classified as low-risk (0 or 1 risk factor), intermediate-risk (2 risk factors), or high-risk (≥ 3 risk factors), which were associated with survival rates of 81% (95% CI, 75 – 87), 55% (95% CI, 44 – 66), and 28% (95% CI, 18 – 40), respectively.

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Researchers then validated and confirmed their novel prognostic models in an independent cohort of patients, but found that the PINK-E model was only significantly associated with the high-risk group compared with the low-risk group.


  1. Kim SJ, Yoon DH, Jaccard A, et al. A prognostic index for natural killer cell lymphoma after non-anthracycline-based treatment: a multicentre, retrospective analysis [published online ahead of print February 9, 2016]. Lancet Oncol. doi: 10.1016/S1470-2045(15)00533-1.