Stage I/II Nasal NK Cell Lymphoma

The Study Treatments:

Radiation therapy is designed to kill cancer cells or to stop cancer cells from growing.

CHOP chemotherapy is made up of the drugs cyclophosphamide, hydroxydaunorubicin
(doxorubicin), oncovin (vincristine), and prednisone. It is designed to help control the
tumor locally as well as the tumor cells that might have escaped and moved through the body.

Radiation Therapy:

You will receive radiation therapy 5 days a week for 28 to 30 treatments. You will receive
a separate consent form that will describe this procedure and its risks in more detail.

Study Visits During Radiation Therapy:

Every week for 6 weeks during radiation therapy:

- You will be asked how you are feeling and about any side effects you may be having.

- Your performance status will be recorded.

- You will have a physical exam.

Chemotherapy Administration:

The amount of time after you finish radiation therapy before you can begin receiving
chemotherapy will depend on your recovery time and any side effects you may have. This
should be about 3-4 weeks.

On Day 1 you will receive cyclophosphamide by vein over 1 hour, doxorubicin by vein over 15
minutes, and vincristine by vein over 15 minutes. You will take prednisone by mouth on Days
1-5 of each cycle. Each cycle will be 21-days long (or longer if it takes longer for your
blood counts to recover). You will receive up to 4 cycles of chemotherapy.

Study Visits During Chemotherapy:

Before Day 1 of Cycle 1:

- You will have a CT scan of head, neck, chest, abdomen and pelvis.

- You will have an MRI scan of the head and neck.

- You will be asked about any drugs you may be taking and symptoms you may be having.

- Your performance status will be recorded.

- You will have a physical exam, including measurement of your height and weight.

- You will have an ECHO and MUGA scan.

- You will have an x-ray of the chest.

- You will have an ECG.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- If you are able to become pregnant, you will have a blood (about 2 teaspoons) pregnancy
test.

On Day 15 of Cycle 1:

- You will be asked about any drugs you may be taking and symptoms you may be having.

- Your performance status will be recorded.

- Blood (about 2 teaspoons) will be drawn for routine tests.

On Day 1 of Cycles 2-4:

- You will be asked about any drugs you may be taking and symptoms you may be having.

- Your performance status will be recorded.

- You will have an ECG.

- Blood (about 2 teaspoons) will be drawn for routine tests.

On Day 15 of Cycles 2-4:

-Blood (about 2 teaspoons) will be drawn for routine tests.

Length of Study:

You may receive radiation and up to 4 cycles of CHOP. You will no longer be able to
receive CHOP if the disease gets worse or intolerable side effects occur.

Your participation on the study will be over after the end-of-study and follow-up visits.

Follow-Up and End-of-Study Visits:

If you leave the study early:

- You will have a CT scan of head, neck, chest, abdomen and pelvis.

- You will have an MRI scan of the head and neck.

- You will have a PET/CT scan.

- Any skin lesions that you may have that are related to the tumor will be measured and
photographed.

- You will be asked about any drugs you may be taking and symptoms you may be having.

- Your performance status will be recorded.

- You will have a physical exam.

- Blood (about 2 teaspoons) will be drawn for routine tests.

Routine Follow-up:

- You will also have routine follow-up visits every 3 months for the 1st year, every 4
month during the 2nd year, and every 6 months during the 3rd-5th years. After that,
you will have follow up visits 1 time every year. At these visits, the following tests
and procedures will be recorded:

- You will have a CT scan of head, neck, chest, abdomen and pelvis.

- You will have an MRI scan of the head and neck.

- You will have a PET/CT scan.

- You will be asked about any symptoms you may be having.

- Blood (about 2 teaspoons) will be drawn for routine tests.

This is an investigational study. Radiation and CHOP are FDA approved and commercially
available for patients with stage 1 and/or 2 NK cell lymphoma. The collection of long term
information about this treatment is investigational.

Up to 40 patients will take part in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. Patients with newly diagnosed stage I and II nasal NK cell lymphoma.

2. Adequate blood cell counts (i.e. ANC > 1000) at baseline, or willingness to accept
supportive measures such as transfusions, filgrastim, and Epoetin. Epoetin will not
be administered concurrently with radiation.

3. Patients must have adequate liver function as indicated by: *Bilirubin the upper limit of normal (ULN), * Alanine transaminase (ALT) or aspartate transaminase (AST) ≤ 2 times the ULN, *These values must be obtained
within two weeks before protocol entry.

4. Patients are required to have adequate renal function as indicated by a serum
creatinine entry.

5. Left ventricular ejection fraction must be evaluated by nuclear medicine scan or
echocardiography and measure >/= 50%.

6. Male patients must agree to use a barrier method of contraception or agree to abstain
from heterosexual activity for the duration of the study.

7. Female patients must be willing to use two adequate barrier methods of contraception
to prevent pregnancy or agree to abstain from heterosexual activity throughout the
study or be post menopausal (free from menses > two years or surgically sterilized).

8. Female patients of childbearing potential must have a negative serum pregnancy test
(BhCG) within 2 weeks of protocol entry.

9. Patients must have the ability to give informed consent.

Exclusion Criteria:

1. Patients with active Hepatitis B and/or Hepatitis C infection.

2. Patients with active infections requiring specific anti-infective therapy are not
eligible until all signs of infections are resolved.

3. Patients known to be HIV positive.

4. Patients with pre-existing cardiovascular disease requiring ongoing treatment. This
includes: a) Congestive heart failure class III/IV CHF per new york heart association
(NYHA) criteria. b) Cardiomyopathy, c) Uncontrolled cardiac arrhythmia, d) Unstable
angina pectoris, e) Recent MI (within 6 months).

5. Patients with prior exposure to anthracyclines:

6. Patients who are pregnant or breast-feeding.

7. Patients with psychiatric illness and/or social situations that would limit
compliance with the study medication and requirements.

8. Prior radiation to the site of current primary disease, if re-treatment would lead to
violation of known radiation dose tolerance limits for that site.