Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

Abstract

Key Points• Patients with early-stage extranodal nasal-type NKTCL were classified as low risk or high risk using 5 independent prognostic factors.• Risk-adapted therapy of RT alone for the low-risk group and RT consolidated by CT for the high-risk group proved the most effective treatment.The optimal combination and sequence of radiotherapy (RT) and chemotherapy (CT) for extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) are not well-defined. The aim of this study was to create a risk-adapted therapeutic strategy for early-stage NKTCL.A total of 1273 early-stage patients from 10 institutions were reviewed. Patients received CT alone (n 5 170), RT alone (n 5 253), RT followed by CT (n 5 209), or CT followed by RT (n 5 641). A comprehensive comparative study was performed using multivariable and propensity score-matched analyses. Early-stage NKTCL was classified as low risk or high risk based on 5 independent prognostic factors (stage, age, performance status, lactate dehydrogenase, primary tumor invasion). RT alone and RT with or without CT were more effective than CT alone (5-year overall survival [OS], 69.6% and 67.7% vs 33.9%, P < .001).For low-risk patients, RT alone achieved a favorable OS (88.8%); incorporation of induction or consolidation CT did not provide additional benefit (86.9% and 86.3%). For highrisk patients, RT followed by CT resulted in superior OS (72.2%) compared with induction CT and RT (58.3%, P 5 .004) or RT alone (59.6%, P 5 .017). After adjustment, similar significant differences in OS were still observed between treatment groups. New CT regimens provided limited benefit in early-stage NKTCL. Risk-adapted therapy involving RT alone for low-risk patients and RT consolidated by CT for high-risk patients is a viable, effective strategy for early-stage NKTCL. (Blood. 2015;126(12):1424-1432 Medscape Continuing Medical Education online This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 1517.

Survival benefit of radiotherapy on patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma: an analysis of the surveillance epidemiology and end results database

“…Kaplan-Meier analysis showed that OS was associated with Ann Arbors stage and RT (p < 0.05), but not associated with sex, age at diagnosis, race, era of diagnosis, histology and B symptoms (p > 0.05). It was consistent with the previous literature reports [12,21,22,[28][29][30][31][32]. Multivariate Cox regression analysis revealed that Ann Arbor stage and RT were both significantly associated with OS and CSS (p < 0.05).…”

“…Currently, radiotherapy (RT) is the most widely used treatment for patients with early-stage ENKTL. Depressingly, the clinical efficacy of RT reported was controversial [6,9,[12][13][14][15]. Few prospectively designed, randomized and controlled clinical trials have been conducted to explore the survival benefit of RT for early-stage ENKTL patients and current evidence mainly relies on retrospective studies and series case reports with small samples.…”

“…Few prospectively designed, randomized and controlled clinical trials have been conducted to explore the survival benefit of RT for early-stage ENKTL patients and current evidence mainly relies on retrospective studies and series case reports with small samples. Additionally, most of them were conducted in Asian countries [6,9,[12][13][14][16][17][18][19][20]. In view of above, we conducted a population-based analysis of patients with early-stage ENKTL from the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the survival benefit associated with RT and investigate the prognostic factors for early-stage ENKTL patients.…”

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

“…A recent retrospective analysis of more than 1,200 patients with stage I/II nasal NK/T-cell lymphoma showed that radiotherapy alone for the low-risk patients (age < 60 years; Eastern Cooperative Group performance score <2; stage I disease; normal lactate dehydrogenase, LDH; no primary tumor invasion into surrounding tissue) was associated with a relapse rate of 19%. 47 On the other hand, for high-risk patients, addition of chemotherapy to radiotherapy conferred survival advantage. The 5-year overall survival (OS) for patients treated with radiotherapy followed by chemotherapy was 72.8%, compared with 57.9% in patients treated with radiotherapy alone.…”

Nasalis típusú extranodalis natural killer T-sejtes lymphoma hazai előfordulása és kezelésével szerzett tapasztalatok

“…Yang és mtsai retrospektív, multicentrikus tanulmányuk alapján IPI low-risk, 60 év alatti I. stádiumú betegcsoporton belül az ötéves PFS 79,2%, az OS 88,8% volt. Annak ellenére, hogy a betegség lokalizált volt, mégis jelentős számban figyeltek meg relapsust [14]. Agresszív lymphomákban, elsősorban DLBCL-ben alkalmazott IPIscore az ENKTL-betegek prognózisának precíz előrejel-zésében bizonyos korlátokat mutatott.…”