Clinical features and treatment of natural killer/T cell lymphoma associated with hemophagocytic syndrome: comparison with other T cell lymphoma associated with hemophagocytic syndrome

Natural killer (NK)/T cell lymphoma associated with hemophagocytic syndrome (NK/T-LAHS) is a rare and life-threatening disease. The clinical features and overall survival of NK/T cell and other T cell lymphomas associated with hemophagocytic syndrome remain uncertain. We retrospectively reviewed the clinical records of 15 patients with NK/T-LAHS and 14 patients with other T-LAHS from December 2008 to June 2013. Patients with NK/T cell lymphoma had a higher International Prognostic Index (p = 0.045) and were more likely to be positive for Epstein-Barr virus (p = 0.025) than those with T cell lymphoma. The level of aspartate aminotransferase (AST) was significantly higher than that of alanine aminotransferase (ALT) in the NK/T-LAHS group (p = 0.005), as well as in the T-LAHS group (p = 0.019). The level of direct bilirubin (DBIL) was more likely to be elevated than that of indirect bilirubin (IBIL) in patients with NK/T-LAHS (p = 0.047), while there was no significant difference in the T-LAHS group (p = 0.124). The median survival time for patients with NK/T and T cell lymphoma was 28 and 33 days, respectively (p = 0.726). However, in the NK/T-LAHS group, the median survival time of patients treated with and without pegaspargase was 116 and 15 days, respectively (p = 0.003). Our results suggest that patients with NK/T-LAHS are at higher risk and suffer a worse prognosis. However, the use of pegaspargase could benefit patients and lead to long-term overall survival.