Progression-free survival at 24 months and subsequent survival of patients with extranodal NK/T-cell lymphoma: a China Lymphoma Collaborative Group (CLCG) study

Abstract

Limited evidence supports the use of early endpoints to evaluate the success of initial treatment of extranodal NK/T-cell lymphoma (ENKTCL) in the modern era. We aim to analyze progression-free survival at 24 months (PFS24) and subsequent overall survival (OS) in a large-scale multicenter cohort of patients. 1790 patients were included from the China Lymphoma Collaborative Group (CLCG) database. Subsequent OS was defined from the time of PFS24 or progression within 24 months to death. OS was compared with age- and sex-matched general Chinese population using expected survival and standardized mortality ratio (SMR). Patients who did not achieve PFS24 had a median OS of 5.3 months after progression, with 5-year OS rate of 19.2% and the SMR of 71.4 (95% CI, 62.9–81.1). In contrast, 74% patients achieved PFS24, and the SMR after achieving PFS24 was 1.77 (95% CI, 1.34–2.34). The observed OS rate after PFS24 versus expected OS rate at 5 years was 92.2% versus 94.3%. Similarly, superior outcomes following PFS24 were observed in early-stage patients (5-year OS rate, 92.9%). Patients achieving PFS24 had excellent outcome, whereas patients exhibiting earlier progression had a poor survival. These marked differences suggest that PFS24 may be used for study design and risk stratification in ENKTCL.

Association of improved overall survival with decreased distant metastasis following asparaginase-based chemotherapy and radiotherapy for intermediate- and high-risk early-stage extranodal nasal-type NK/T-cell lymphoma: a CLCG study

“…However, given the severe toxicities 9,10,14 and low risk of central nervous system involvement, 51 the role of incorporation of MTX into ASP-based regimens remains uncertain for the first-line CMT of early-stage ENKTCL. Using PFS at 24 months as an efficacy endpoint, 52 further work is needed to optimize systemic therapies or novel regimens with inclusion of ASP and radiotherapy in intermediate-and high-risk early-stage patients.…”

Vías moleculares patogénicas del linfoma T/NK extranodal de tipo nasal asociadas con virus de Epstein Barr: Revisión narrativa

“…El ENKTL es una enfermedad altamente mortal, con una supervivencia entre el 10-40% en estadios diseminados (Yang et al, 2021) en contraste con los estadios tempranos en los que se ha reportado un buen pronóstico (Hong et al, 2019;Lehrich et al, 2021). El tumor suele iniciar en la región nasal, infiltrando frecuentemente el paladar, senos paranasales, amígdala y anillo de Waldeyer.…”

Histone deacetylases inhibitor chidamide synergizes with humanized PD1 antibody to enhance T-cell chemokine expression and augment Ifn-γ response in NK-T cell lymphoma

“…The 5-year overall survival rate in the era of l -asparaginase is still less than 40%. 3 , 4 Optional therapies for R/R NKTCL are limited and most options are intolerable for elder or fragile patients. Combination chemotherapy regimens, such as DHAP (dexamethasone-cytarabine-cisplatin), ICE (ifosfamide-carboplatin-etoposide), GDP (gemcitabine-dexamethasone-cisplatin), dexamethasone-cisplatin-gemcitabine-asparaginase) and P-Gemox (asparaginase-gemcitabine-oxaliplatin), are the main options.…”

“…Combination chemotherapy regimens, such as DHAP (dexamethasone-cytarabine-cisplatin), ICE (ifosfamide-carboplatin-etoposide), GDP (gemcitabine-dexamethasone-cisplatin), dexamethasone-cisplatin-gemcitabine-asparaginase) and P-Gemox (asparaginase-gemcitabine-oxaliplatin), are the main options. However, the median age of NKTCL is approximately 44 years, 4 and patients are usually older and in a frail state after a first-line combination chemotherapy regimen. More effective new drugs and combinations, especially chemo-free regimens, are required.…”