IPI score is calculated as 0 and there is evidence this may be prognostic to some extent in NK lymphomas.
The MDT had no trials available so felt SMILE (Dexamethasone, methotrexate, Ifosfamide, L-Asparaginase and Etoposide) chemotherapy was a suitable option, given NK/T cell lymphomas have high expression of P-glycoprotein rendering them anthracycline resistant.
He is treated with SMILE chemotherapy with two cycles and Radiotherapy and then a further two cycles of SMILE.
His PET scan post treatment confirms CR and his EBV peripheral blood PCR is undetectable. He continues to have regular clinic review and EBV PCR testing monitoring for late relapse.