Sequential chemotherapy/radiotherapy was comparable with concurrent chemoradiotherapy for stage I/II NK/T-cell lymphoma

Kwong, Yok–Lam; Kim, S. J.; Tse, Eric; Oh, Sung Yong; Kwak, Jae-Yong; Eom, Hyeon Seok; Do, Y. R.; Mun, Yeung‐Chul; Lee, S. R.; Shin, Ho-Jin; Suh, Cheolwon; Chuang, S. S.; Lee, Y. S.; Lim, Soon Thye; Izutsu, Koji; Suzuki, Ritsuro; Relander, Thomas; d’Amore, Francesco; Schmitz, Norbert; Jaccard, Arnaud; Kim, W. S.

doi:10.1093/annonc/mdx684

Cited by 67 publications

(65 citation statements)

References 16 publications

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“…Recently, multicentric studies demonstrated that non-ANT-based CT followed by RT yielded survival comparable to concurrent chemoradiotherapy in early-stage ENKTCL. 27,28 Others have indicated that early or upfront RT results in better survival than late RT for early-stage patients treated with ASP-based or gemcitabine-based CT. 29,30 However, it is difficult to accurately assess the effect of RT timing on outcomes in small cohorts. We hypothesized that the clinical advantage of early RT depends on the initial response to induction CT.…”

Section: Introductionmentioning

confidence: 99%

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Yang

Zhang

et al. 2020

American J Hematol

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We aimed to determine the survival benefits of chemotherapy (CT) added to radiotherapy (RT) in different risk groups of patients with early‐stage extranodal nasal‐type NK/T‐cell lymphoma (ENKTCL), and to investigate the risk of postponing RT based on induction CT responses. A total of 1360 patients who received RT with or without new‐regimen CT from 20 institutions were retrospectively reviewed. The patients had received RT alone, RT followed by CT (RT + CT), or CT followed by RT (CT + RT). The patients were stratified into different risk groups using the nomogram‐revised risk index (NRI). A comparative study was performed using propensity score‐matched (PSM) analysis. Adding new‐regimen CT to RT (vs RT alone) significantly improved overall survival (OS, 73.2% vs 60.9%, P < .001) and progression‐free survival (PFS, 63.5% vs 54.2%, P < .001) for intermediate‐risk/high‐risk patients, but not for low‐risk patients. For intermediate‐risk/high‐risk patients, RT + CT and CT + RT resulted in non‐significantly different OS (77.7% vs 72.4%; P = .290) and PFS (67.1% vs 63.1%; P = .592). For patients with complete response (CR) after induction CT, initiation of RT within or beyond three cycles of CT resulted in similar OS (78.2% vs 81.7%, P = .915) and PFS (68.2% vs 69.9%, P = .519). For patients without CR, early RT resulted in better PFS (63.4% vs 47.6%, P = .019) than late RT. Risk‐based, response‐adapted therapy involving early RT combined with CT is a viable, effective strategy for intermediate‐risk/high‐risk early‐stage patients with ENKTCL in the modern treatment era.

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Section: Introductionmentioning

confidence: 99%

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Yang

Zhang

et al. 2020

American J Hematol

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“…However, only systematic chemotherapy has the potential to cure patients with advanced or disseminated disease [9,14,35]. Due to the heterogeneity of the disease and variations in the combination and intensity of the first-line treatment for earlystage patients (single modality with radiotherapy or chemotherapy, different sequences of radiotherapy and chemotherapy, various chemotherapy regimens of different intensities) [7,8,12,21], it is important to improve risk stratification models, especially for such a large cohort. In the present study, despite improved survival (5-year OS, 75.5%) with current treatment strategies, the 5-year OS rates for early-stage patients varied substantially from 56.3 to 85.4% when stratified by the NRI into risk groups.…”

Section: Discussionmentioning

confidence: 99%

“…Our institutional ethics review board approved the study and waived the need for informed consent, as patients had been de-identified in the dataset. Given the wide use of new chemotherapy regimens and modern radiotherapy in the past decade [21,22], the eligibility criteria for this validation study included: (1) patients who had received initial treatment between 2008 and 2016; (2) patients who had received non-anthracycline-based chemotherapy with or without radiotherapy, or radiotherapy alone as the first-line treatment. The exclusion criteria were: (1) patients treated before 2008; (2) anthracycline-based or unknown chemotherapy regimens; (3) dataset from the study of our original nomogram.…”

Section: Eligibility Criteria and Study Populationmentioning

confidence: 99%

“…We previously developed and validated a nomogram for predicting survival for individual patients who were mostly treated with anthracycline-based chemotherapy and conventional radiotherapy [19]. Recently, efforts to improve the model's discrimination have focused on adding new prognostic factors, regrouping the original prognostic index in various cohorts, or specifically focusing on early-stage patients [12,20,21]. None of these models has undergone comprehensive evaluation to provide further evidence for efficacy and general applicability.…”

Section: Introductionmentioning

confidence: 99%

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Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

et al. 2020

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Derived from our original nomogram study by using the risk variables from multivariable analyses in the derivation cohort of 1383 patients with extranodal NK/T-cell lymphoma, nasal-type (ENKTCL) who were mostly treated with anthracyclinebased chemotherapy, we propose an easily used nomogram-revised risk index (NRI), validated it and compared with Ann Arbor staging, the International Prognostic Index (IPI), Korean Prognostic Index (KPI), and prognostic index of natural killer lymphoma (PINK) for overall survival (OS) prediction by examining calibration, discrimination, and decision curve analysis in a validation cohort of 1582 patients primarily treated with non-anthracycline-based chemotherapy. The calibration of the NRI showed satisfactory for predicting 3-and 5-year OS in the validation cohort. The Harrell's C-index and integrated Brier score (IBS) of the NRI for OS prediction demonstrated a better performance than that of the Ann Arbor staging system, IPI, KPI, and PINK. Decision curve analysis of the NRI also showed a superior outcome. The NRI is a promising tool for stratifying patients with ENKTCL into risk groups for designing clinical trials and for selecting appropriate individualized treatment. 1234567890();,:1234567890();,:

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“…Among 303 patients, the impact of types of treatment on CR, OS, and PFS rates is evaluated. When effective chemotherapeutic regimens are used, concurrent and sequential chemoradiotherapy give similar outcome . Another multicenter retrospective study of 215 patients compares the efficacy of L‐saparaginase/pegaspargase‐based sequential versus sandwich chemoradiotherapy.…”

Section: Treatmentmentioning

confidence: 99%

What we should know about natural killer/T‐cell lymphomas

Xiong

Zhao

2019

Hematological Oncology

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Natural-killer/T cell lymphoma (NKTCL) is the most common extranodal lymphoma with highly aggressive clinical outcome. System biology techniques provide novel insights into the pathogenesis, risk stratification, and clinical management in NKTCL. Comparative genomic hybridization analysis reveal most frequent deletion of chromosome 6q21. Whole-exome sequencing studies identify recurrent somatic gene mutations, involving RNA helicases, tumor suppressors, JAK-STAT pathway molecules, and epigenetic modifiers. Genome-wide association study reports strongest association of HLA-DPB1 rs9277378 with lymphomagenesis. Alterations of oncogenic signaling pathways as well as epigenetic dysregulation of microRNA and long non-coding RNAs are also observed in NKTCL. Epstein-Barr virus (EBV) is the major etiology of NKTCL and the pathogenic mechanism remains unclear. Different risk stratification models are proposed based on clinical parameters (IPI, PINK, and PINK-E, etc.) or biomarkers (Ki67, C-reactive protein level, and EBV DNA, etc.).Therapeutic strategies vary according to disease stage, including radiotherapy, asparaginase-based chemotherapy, hematopoietic stem-cell transplantation, targeted therapy (immune checkpoints inhibitors, and histone deacetylation inhibitors, etc.).Future investigations will be emphasized on EBV-related pathogenesis of NKTCL, prognostic and therapeutic biomarkers, as well as multi-center clinical trials, so as to optimize personalized treatment of NKTCL in the era of precision medicine.

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Sequential chemotherapy/radiotherapy was comparable with concurrent chemoradiotherapy for stage I/II NK/T-cell lymphoma

Abstract: In stage I/II NK/T-cell lymphomas, when effective chemotherapeutic regimens were used, CCRT and sequential CT + RT gave similar outcome.

Cited by 67 publications

References 16 publications

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

Validation of nomogram-revised risk index and comparison with other models for extranodal nasal-type NK/T-cell lymphoma in the modern chemotherapy era: indication for prognostication and clinical decision-making

What we should know about natural killer/T‐cell lymphomas

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