Five‐year analysis from phase 2 trial of “sandwich” chemoradiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T‐cell lymphoma

Abstract

The “sandwich” protocol, was first proposed by us and comprised of l‐asparaginase, vincristine, and prednisone chemotherapy with radiotherapy, results in 2‐year overall survival and progression‐free survival rates that surpass traditional therapies for patients with newly diagnosed, stage IE‐IIE, nasal type, extranodal natural killer/T‐cell lymphoma. The results had been published by cancer. These patients were followed up over a median period of 67 months, for which updates and the results of prognostic factors analyses are presented. The 5‐year overall survival and progress‐free survival rates were both 64%. The highest rates of death occurred during the first 6 months, and between the second and third year after enrollment. The initial therapeutic response (odds ratio = 5.83; P = 0.001) and B symptoms (odds ratio = 6.13; P = 0.043) were significant prognostic factors for overall survival. However, the international prognostic index was not significant for progress‐free survival and overall survival. There were no severe long‐term side effects. These results indicate that the “sandwich” protocol may benefit the long‐term survival of patients with newly diagnosed stage IE‐IIE, nasal type, extranodal natural killer/T‐cell lymphoma. However, additional studies with larger samples are required to confirm these results. This study is registered at www.Chictr.org (ChicTR‐TNC‐09000394).

Gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy with sandwiched radiotherapy in the treatment of newly diagnosed stage IE/IIE extranodal natural killer/T‐cell lymphoma, nasal type

“…Asparaginase‐based or pegaspargase‐based regimens provided favorable outcomes in newly diagnosed and relapse/refractory ENKL, nasal type . Several phase II studies with asparaginase‐based or pegaspargase‐based regimens combined with early RT has been shown to be effective for the treatment of newly diagnosed stage I/II ENKL . However, the toxicity profiles of above regimen limited its wide range of clinical application, especially for early‐stage ENKL.…”

“…Several studies have demonstrated that the gemcitabine alone and/or containing regimen had high clinical activity and low toxicity both in the treatment of T‐cell unspecified lymphoma and in refractory or relapsed NK/T‐cell lymphoma . Meanwhile, the sandwich combined modality therapy has achieved an excellent outcome for localized ENKL with acceptable toxicity . Here, we reported a retrospective study evaluating the efficacy and safety profiles of the sandwich protocol in 72 patients with newly diagnosed stage IE/IIE ENKL, nasal type: an initial 2 cycles of gemcitabine, dexamethasone, and cisplatin (GDP), followed by earlier involved‐field radiation therapy (IFRT), and further 2 to 4 cycles consolidation CT.…”

Diagnosis and management of extranodal NK/T cell lymphoma nasal type

“…The 5-year OS and PFS were both 64%. 57 The high systemic failure rate implied that this regimen was not intensive enough to deal with occult dissemination.…”

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

“…13 Sandwich chemoradiation (2 cycles of chemotherapy followed by involved-field RT [56 Gy] followed by 2-4 cycles of chemotherapy within 7 days of completion of involved-field RT) with asparaginase-or pegaspargase-based chemotherapy has been shown to be effective for the treatment of patients with newly diagnosed stage I-II ENKL-NT. [38][39][40] In a phase II study of 27 patients, sandwich chemoradiation with GELOX (L-asparaginase/gemcitabine/oxaliplatin) resulted in an ORR of 96% (CR, 74%). After a median follow-up of 63 months, 5-year OS and PFS rates were 85% and 74%, respectively.…”