Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma

Yao, Yihong; Tang, Yong; Zhuang, Yan; Zou, Li-fang; Dou, Huan; Wang, Lei; Zhu, Qi

doi:10.1007/s12288-016-0670-2

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Several studies have demonstrated that stage III/IV ENKTL patients with primary site of upper aerodigestive tract have a more favorable clinical outcome than those originating in non-upper aerodigestive tract. 18 Similar to these researches, our result showed that the response rate and 3-year survival rate was significantly higher in patients with UAT advanced stage ENKTL, indicating that this unique group of patients may be different in the pathogenesis and need to be explored as a single entity.…”

Section: Discussionsupporting

confidence: 83%

The Clinical Features and Survival Outcome of 107 Newly Diagnosed Advanced Stage Extranodal NK/T-Cell Lymphoma Cases: A Triple-Center Study

Zhong

et al. 2021

CMAR

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Objective Advanced stage extranodal natural killer/T-cell lymphoma (ENKTL) is a distinct type of non-Hodgkin lymphoma and the prognosis of ENKTL is poor with current treatment. This study aimed to investigate the clinical features, treatment strategy and survival outcome in patients with advanced stage ENKTL. Patients and Methods A total of 107 patients with newly diagnosed advanced stage ENKTL between January 2010 and December 2014 were reviewed from three cancer centers. Survival probability was calculated using Kaplan-Meier and the survival curves were compared by Log rank test. Cox regression analyses was performed to investigate the prognostic factors in ENKTL. Results The median patient age in our cohort was 42.0 years, with a male to female ratio of around 2.3:1. Over half of the patients had B symptoms (n = 61), high IPI scores (≥ 2, n = 60) and high Prognostic Index of Natural Killer Lymphoma (PINK) scores (≥ 3, n = 69). Elevated LDH level was present in around half of the patients (44/91). Most patients (n = 88) in our cohort originated in upper aerodigestive tract and the remaining 19 cases presented with non-upper aerodigestive tract involvement at first diagnosis. Chemotherapy regimens used in our study mainly include CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) (n = 26), L-asparaginase (L-asp) containing chemotherapy (GELOXD (gemcitabine, l-asparaginase, oxaliplatin and dexamethasone) and SMILE (L-asparaginase, methotrexate, ifosfamide, etoposide, and dexamethasone)) (n = 66). No significant difference between the baseline clinical characteristics was found between the L-asp and CHOP group. The CR rate after treatment was 39.3% (42/107) for the whole cohort. The 3-year progression-free survival (PFS) and 3-year overall survival (OS) rate was 41.0% and 41.5%, respectively. The 3-year PFS (49.2% vs 26.5%, P = 0.048) and 3-year OS (49.4% vs 26.0%, P = 0.030) was significantly higher in the L-asp group than the CHOP group. Patient CR status and PINK score were proved to be significant independent factors affecting OS and PFS by multivariate analysis. The grade 3/4 hematologic toxicity (P = 0.0003) and non-hematologic toxicity (P = 0.0002) occurred more frequently in the SMILE group than the GELOXD group. Conclusion Our results demonstrated that L-asp containing chemotherapy could provide favorable survival outcomes in patients with advanced stage ENKTL.

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Section: Discussionsupporting

confidence: 83%

The Clinical Features and Survival Outcome of 107 Newly Diagnosed Advanced Stage Extranodal NK/T-Cell Lymphoma Cases: A Triple-Center Study

Zhong

et al. 2021

CMAR

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“…Conclusively speaking, the present cohort achieved an mOS of 26.07 months and an estimated 5-year OS of 41.3%, much more gratifying than previously reported in retrospective real-world settings [11, 12, 15, 19, 36‒38]. First, CT with efficient regimen, standard dose, and duration could contribute to maximizing the survival benefit.…”

Section: Discussionsupporting

confidence: 66%

Treatment and Prognosis of Newly Diagnosed Advanced-Stage Extranodal Natural Killer/T-Cell Lymphoma: A Single-Center Real-World Study across Two Decades

Wei,

Qi,

Chen

et al. 2023

Chemotherapy

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Introduction: Although there is now a consensus on asparaginase-based chemotherapy regimens in the treatment of advanced-stage extranodal natural killer/T-cell lymphomas (ENKTCLs), patient survival in the real-world setting is still not optimistic according to previous literature reports, and the optimal chemotherapeutic regimens and integration of different therapeutic methods under the concept of combined-modality treatment still need to be further explored and verified. Methods: Newly diagnosed stage Ⅲ/Ⅳ ENKTCL patients from Chinese National Cancer Center in the last two decades were retrospectively collected and analyzed. Overall survival (OS) and progression-free survival (PFS) were determined as primary endpoints. Log-rank tests and Cox proportional hazard models were performed to test for survival differences between subgroups and examine the univariable and multivariable associations. Results: The study included 83 newly diagnosed stage Ⅲ/Ⅳ ENKTCL patients and reported a median OS of 26.07 months and an estimated 5-year OS of 41.3% with a median follow-up of 82.13 months. First-line asparaginase-based regimens compared to non-asparaginase-based regimens significantly prolonged PFS (p = 0.007; HR = 0.48, p = 0.020) and showed a tendency to improve OS (p = 0.064; HR = 0.74, p = 0.359). Gemcitabine-based regimens also exhibited a trend toward improved PFS (p = 0.048; HR = 0.59, p = 0.164) and OS (p = 0.008; HR = 0.67, p = 0.282) compared to non-gemcitabine-based ones. The asparaginase and gemcitabine combinations yielded a 5-year OS of 55.0% and led to significantly superior PFS (p = 0.020; HR = 0.40, p = 0.022) and slightly better OS (p = 0.054; HR = 0.79, p = 0.495) compared to the remaining regimens. First-line combined-modality treatment integrating chemotherapy and radiotherapy improved PFS (p = 0.051) and OS (p = 0.036) compared to chemotherapy alone. Four autologous hematopoietic stem cell transplantation recipients reached a median OS of 58.34 months. Conclusion: Asparaginase and gemcitabine alone brought a favorable impact on PFS and OS; and the asparaginase and gemcitabine combination chemotherapy yielded the optimal efficacy, response duration, and survival outcomes. Combined-modality treatment including potent chemotherapy supplemented by radiotherapy and/or consolidative transplantation could improve prognosis in newly diagnosed advanced-stage ENKTCLs.

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“…The median number of MNC cells was 10.2 × 10 8 /kg (3.37–21.11 × 10 8 /kg), and that of CD34 + cells was 4.3 × 10 6 /kg (1.33–12.06 × 10 6 /kg). The median time to neutrophil engraftment was 12 8–15 days, and that of platelet engraftment was 15 7–21 days.…”

Section: Resultsmentioning

confidence: 99%

“…8 Overtime, asparaginase-based chemotherapy regimens have been used mainly for patients with ENKTL, and the survival rate after 5 years was about 40%. [9][10][11] American Society for Blood and Marrow Transplantation (ASBMT) suggested that hematopoietic stem cell transplantation should be used as a first-line treatment. 12 Till date, optimal treatment strategies and prognosis for patients with advanced ENKTL have not been fully defined.…”

Section: Introductionmentioning

confidence: 99%

“…This is partly due to its intrinsic ENKTL resistance to anthracycline caused by high expression levels of P‐glycoprotein 8 . Overtime, asparaginase‐based chemotherapy regimens have been used mainly for patients with ENKTL, and the survival rate after 5 years was about 40% 9–11 . American Society for Blood and Marrow Transplantation (ASBMT) suggested that hematopoietic stem cell transplantation should be used as a first‐line treatment 12 .…”

Section: Introductionmentioning

confidence: 99%

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Up‐front autologous hematopoietic stem cell transplantation after first complete remission improved prognosis of advanced extra‐nodal NKT cell lymphoma: A multicenter real‐world study in China

Gao

Lin

et al. 2023

European J of Haematology

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Objectives The advanced extra‐nodal NK/T‐cell lymphoma (ENKTL) is highly aggressive and lacks effective treatment with a poor prognosis. This study aimed to investigate the effectiveness and safety of autologous hematopoietic stem cell transplantation (ASCT) in CR1. Methods Forty of 121 patients with advanced ENKTL from four Chinese hospitals between January 2006 to December 2021 who achieved first complete remission (CR1) and received at least 4 cycles chemotherapy, were enrolled for analysis. Twenty patients received ASCT as up‐front consolidation therapy (Group A), and 20 patients only received chemotherapy (Group B). Clinical features, treatment and follow‐up information were collected. Results With a median follow‐up of 27 months (range, 4–188 months), the 2‐year overall survival (OS) in Group A, 61% (95% CI 37%–85%), was better than that in Group B, 26% (95% CI 2%–50%), p = .018. The 2‐year progression‐free survival (PFS) was 56% (95% CI 32%–80%) in Group A, 26% (95% CI 2%–50%) in Group B, p = .026. III–IV grade hematological toxicity was the most common adverse event. No treatment‐related deaths were observed in both groups. Conclusion Up‐front ASCT could improve survival of advanced ENKTL patients in first complete remission, but need be confirmed by a prospective clinical trial.

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Retrospective Study of Pegaspargase, Gemicitabine, Oxaliplatin and Dexamethasone (Peg-GemOD) as a First-Line Therapy for Advanced-Stage Extranodal NK/T Cell Lymphoma

Cited by 7 publications

References 20 publications

The Clinical Features and Survival Outcome of 107 Newly Diagnosed Advanced Stage Extranodal NK/T-Cell Lymphoma Cases: A Triple-Center Study

The Clinical Features and Survival Outcome of 107 Newly Diagnosed Advanced Stage Extranodal NK/T-Cell Lymphoma Cases: A Triple-Center Study

Treatment and Prognosis of Newly Diagnosed Advanced-Stage Extranodal Natural Killer/T-Cell Lymphoma: A Single-Center Real-World Study across Two Decades

Up‐front autologous hematopoietic stem cell transplantation after first complete remission improved prognosis of advanced extra‐nodal NKT cell lymphoma: A multicenter real‐world study in China

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