T-cell lymphoma
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Extranodal NK/T-cell lymphoma, nasal type
SMILE
Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide
Regimen
- Dexamethasone (Decadron) 40 mg PO/IV daily on days 2,3,4
- Methotrexate (MTX) 2 g/m2 IV once over 6 hours on day 1
- Folinic acid (Leucovorin) 15 mg PO q6h on days 2,3,4 beginning 24 hours after completion of MTX
- Ifosfamide (Ifex) 1500 mg/m2 IV once daily on days 2,3,4
- Mesna (Mesnex) 300 mg/m2 IV q8h on days 2,3,4
- Asparaginase (Elspar) 6000 units/m2 IV once daily over 2 hours on days 8,10,12,14,16,18,20
- Etoposide (Vepesid) 100 mg/m2 IV once daily on days 2,3,4
Supportive Medications
- Filgrastim (Neupogen) SC/IV daily from day 6 until WBC > 5 x 10^9/L
- Trimethoprim/Sulfamethoxazole (Bactrim DS) recommended
28-day cycles for 2 cycles
References
- Yamaguchi M, Suzuki R, Kwong YL, Kim WS, Hasegawa Y, Izutsu K, Suzumiya J, Okamura T, Nakamura S, Kawa K, Oshimi K. Phase I study of dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy for advanced-stage, relapsed or refractory extranodal natural killer (NK)/T-cell lymphoma and leukemia. Cancer Sci. 2008 May;99(5):1016-20. doi:10.1111/j.1349-7006.2008.00768.x. Epub 2008 Feb 19. link to article contains protocol PubMed
- Yamaguchi M, Kwong YL, Kim WS, Maeda Y, Hashimoto C, Suh C, Izutsu K, Ishida F, Isobe Y, Sueoka E, Suzumiya J, Kodama T, Kimura H, Hyo R, Nakamura S, Oshimi K, Suzuki R. Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol. 2011 Nov 20;29(33):4410-6. doi: 10.1200/JCO.2011.35.6287. Epub 2011 Oct 11. link to article contains verified protocol PubMed
NK/T-cell lymphoma
SMILE
Steroid (dexamethasone), Methotrexate, Ifosfamide, L-asparaginase, Etoposide
Regimen
- Dexamethasone (Decadron) 40 mg PO daily on days 2,3,4
- Methotrexate (MTX) 2 g/m2 IV once over 6 hours on day 1
- Folinic acid (Leucovorin) 45 mg PO q6h on days 2,3,4 beginning 24 hours after completion of MTX
- Ifosfamide (Ifex) 1500 mg/m2 IV once daily (admix with mesna) over 6 hours on days 2,3,4
- Mesna (Mesnex) 900 mg/m2 IV once daily (admix with ifosfamide) over 6 hours on days 2,3,4
- Asparaginase (Elspar) 6000 units/m2 IV once daily over 2 hours on days 8,10,12,14,16,18,20
- Etoposide (Vepesid) 100 mg/m2 IV once daily over 2 hours on days 2,3,4
Supportive Medications
- Filgrastim (Neupogen) 300 mcg SC daily from day 6 until ANC > 1 x 10^9/L
- Cotrimoxazole or Pentamidine (Nebupent) for PJP prophylaxis
28-day cycles up to 6 cycles
References
- Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E, Leung AY, Chim CS. SMILE for natural killer/T-cell lymphoma: analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood. 2012 Oct 11;120(15):2973-80. doi:10.1182/blood-2012-05-431460. Epub 2012 Aug 23. link to article verified protocol in supplement PubMed