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The biochemistry of animal bodies is complex and demanding. In biochemistry, we study the functioning of various body cells including tissues and other subsets that play a significant role in the biological and clinical heterogeneity. Of recently, the extranodal natural killer/T-cell lymphoma (ENKL) has taken the world of biochemical research like a storm. Primarily, they are T-cell malignancies composed in the lymphomas and they are useful in both clinical and biological processes. Both radiotherapy and chemotherapy of ENKL are complex processes. As we know, a patient needs radiotherapy especially at the early stages when the disease had not spread. However, at advanced stages, chemotherapy becomes necessary. Nonetheless, at advanced stages, chemotherapy is not possible due to resistance followed by poor prognosis (Kohrt & Advani, 2010, p. 1395).
This paper discusses risk stratification in extra nodal natural killer/T-cell lymphoma. In other words, this article is a summary of various facets of biology, biochemical pathogenesis, and the clinical practices that create impact to not only heterogeneity, but also the development of new techniques of treating ENKL amid the pathologic, genetic, and medical risk factors. Researchers and medics have done their best to unravel the biology and prognosis of lymphoma without much success. Nevertheless, people suffering from ENKL must continuously medical attention in order to minimize chances of going for therapies.
The T-cell NK/T lymphoma is not only a rare biological complication, but also its distinct extranodal characteristics make it complex and a natural killer. The extranodal types include the nasal type (ENKL) and the NK -cell leukemias. According to WHO researchers, an emerging subtype of T-cell lymphoma, NK-cell neoplasm, is under investigation. Of great concern to experts is the aggressive nature of these subtypes given that clinical practices and administration is similar to that of acute leukemia. Depending on one’s geographical location, the complexity of extranodal NK/T-cell lymphoma varies. For instance, in Western countries the most common subtype is sinonasal lymphoma because the people have large B-cell histology. Characterized by a series of systemic symptoms and tissue invasion, medics have not fully discovered the overall prognosis due to frequent relapse or in some cases, resistance to cure. Additionally, other characteristics of ENKL that make it complex include exclusive manifestation and uneven clinical phenotype. Others include the polymorphic nasty reticulosis that exhibits spiteful entities, and lethal midline granuloma appearing in the form of immunoproliferative lesion.
Tumors are common for extranodal natural killer/T-cell lymphoma and they cause vascular destruction. In addition to this, the tumors cause pathological angiocentricity and tissue necrosis making the disease even more complex to treat. However, researchers have devised new methods to investigate this biological complication through NK-cell neoplasms and lineage markers. Based on the immunohistochemistry, it is easier to identify T-cell phenotypes and other associated antigens for example, CD2, CD56 and CD7.
Determining the risks associated with extranodal natural killer/T-cell lymphoma (ENKL) requires a standardized method in order to come up with treatment strategies and encourage clinical research.
According to WHO, identifying ENKL disease is not easy because it can be either nasal or extranasal? However, in most cases, statistics indicate that the disease exhibits itself more in the nasal cavity in the form of tonsils, nasopharynx and larynx just to name a few. The disease can show extranasal tendencies of less than 15 percent in the testis, salivary glands, and other regions such as the spleen and tract. Histologically both nasal and extranasal have the same characteristics but differ due to variations in OS that stand at p= 0.031 at early-stages and p= 0.031 at advanced stages. From the risk assessment, the common symptoms of ENKL include swelling caused by anatomical impediment, purulent rhinorrhea, and perforation of the midline, hemophagocytosis and epistaxis. In fact, at advanced stages, patients with B symptoms can experience severe pain double of that in early stages. The method that the researcher used here was International Prognostic Index (IPI). A sample size and heterogeneity can determine the IPI score.
On the other hand, the biological risk factors are normally the Epstein-Barr viral contagion within the tumors of caused by ENKL in the nasal cavity in addition to the nasopharynx. Experts have also singled out malignant cells as regions that postulate none—oncogenic marker of EBV and embodied in both the nasopharynx and nasal cavity. Nevertheless, from clinical analysis, results indicate that the substantiation of pathogenesis between nasal cavity cells and ENKL. In other words, the genomes in the nasal cavity exhibits sprains in heterogeneity, with only one sprain in EBV appearing in the structure of clonal episomal—very common in ENKL tumor cells. It is also imperative to note that NK-cell tumor is exclusive with 30-base brace erasure in latent membrane protein, as compared to normal cells that have wide-type latent membrane protein (Kohrt & Advani, 2010, pp. 1400-1404).
Results indicate that at early-stages of ENKL, most patients (57%) measure an IPI score of less than one, in comparison with 27.6% who have an IPI of more than one. Nevertheless, about 25-30% of patients can receive radiotherapy at early stages. Chemotherapy regimens can also apply at some stage. However, radiation ought to accompany chemotherapy processes such as cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) to discourage scenarios like lapses, poor response to refractory, and CR rates measuring below 33%. Further, the amount of lactate dehydrogenase, marrow composition, age, and extranodal zones of a specific T-cell determines the prognostic practices, because the IPI method does not give information about low and intermediate risk ENKL patients. The Korean International Prognostic Index also gave tangible results where the researchers identified four variables: B symptoms, Arbor stage, advanced LDH, and lymphadenopathy of the class N1-N3 and not that of M1. From the study, 80.9% of patients with NK/T-cell fell under the category of low risk stratification, while 64.2% had characteristics and symptoms that corresponded to intermediate risks. There is no doubt that these methods are paramount in the study of ENKL disease, however, they remain predictive especially at advanced stages.
L-asparaginase-based therapy is one of the best emerging methods of assessing risk stratification of extranodal T-cell lymphoma. This process aims to stop tumor growth and elongation by depriving cells amino acids, which then inhibits the synthesis in both RNA and DNA.
There is no doubt that studies and various clinical practices have opened a new chapter in the understanding of NK-cell biology. I must point out that these studies have also contributed greatly to the understanding of malignant transformation, the therapy of NK-cell, the functions of EBV, and prognosis. These are some of the basics towards assessing the risk stratification of extranodal NK/T-cell lymphoma. Depending on several factors such as histology, inherent constraints, treatment of this killer disease can be possible. However, in order to minimize risks, it is imperative to use the risk-stratified approach by emphasizing on the initial stage of ENKL. Nonetheless, in order to treat the disease effectively, several clinical trials of the NK/T-cell lymphoma are necessary (Kohrt & Advani, 2010, p. 1405).
Kohrt, H. & Advani, R. (2010). “Risk stratification in extranodal natural killer/T-cell lymphoma”. Expert Review of Anticancer Therapy, 10(9), 1395-1405.