Trial of LVDP regimen (l-asparaginase, etoposide, dexamethasone, and cisplatin, followed by radiotherapy) as first-line treatment for newly diagnosed, stage III/IV extranodal natural killer/T cell lymphoma

Yang, Yong; Zhuo, Hongyu; Zou, Liqun; Jiang, Yuan; Jiang, Ming

doi:10.1007/s12032-014-0435-4

Cited by 13 publications

(10 citation statements)

References 37 publications

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“…100 in each group) were sufficient to compare survival differences between treatment groups. The CR rate with L-asparaginase-based CT in this study was similar to some previous studies, 41,[51][52][53][54][55][56][57] but lower than other studies. 26,27,42,[58][59][60][61][62] The different CR rates in these studies were probably due to small sample size, different clinical stage included, heterogeneous L-asparaginasecontaining regimens and cycles, use of RT, and other unknown factors (see supplemental Table 1 on the Blood Web site).…”

Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 90%

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

Yang

Zhu

Cao

et al. 2015

Blood

156

167

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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.

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Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 90%

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

Yang

Zhu

Cao

et al. 2015

Blood

156

167

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“…Comparing patients who received chemotherapy alone, 31,32 patients with advanced-stage ENKTCL who were able to receive ASCT, had better long-term survival. This result implies that ChiCGB with ASCT could be a consolidation option for patients with advanced-stage ENKTCL.…”

Section: Discussionmentioning

confidence: 95%

A new conditioning regimen with chidamide, cladribine, gemcitabine and busulfan significantly improve the outcome of high‐risk or relapsed/refractory non‐Hodgkin's lymphomas

Jie

Liu

Kuang

et al. 2021

Intl Journal of Cancer

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Previous studies highlight the need for a more active conditioning therapy in highrisk or refractory and relapsed lymphomas. Our preclinical research shows that histone deacetylase inhibitors, such as either vorinostat or chidamide, sensitize lymphoma cells to the cytotoxic combination of cladribine, gemcitabine and busulfan, leading to cell apoptosis. To evaluate the efficacy of this chidamide-cladribinegemcitabine-busulfan (ChiCGB) combination as a new conditioning therapy, we conducted a Phase II trial, as described here. Patients with high-risk, relapsed/refractory lymphomas received ChiCGB as conditioning therapy, after transplantation with autologous peripheral stem cells. The sample comprised 105 patients in total: 60 with B-cell non-Hodgkin lymphomas (B-NHL) and 45 with T-cell or natural killer/T-cell lymphoma (NK/T). All patients eventually achieved full hematopoietic recovery. Neutrophils and platelets were engrafted at a median of 10 days (8-14) and 13 days (8-38), respectively. There was no transplant-related mortality within 100 days of transplant. Neutropenic fever, mucositis and atopic dermatitis were the observed nonhematologic toxicities. At a median follow-up of 35.4 months, 80.6% of the patients presented with no tumor progression, and the overall survival (OS) reached as high as 86.1%. Concerning the OS rate, 94.5% of patients with B-NHL and 75.4% of patients with T-cell or NK/T lymphomas survived. These findings demonstrate the safety and validity of the proposed combined therapy for high-risk and refractory/ relapsed lymphomas. Our study was registered on the Clinical Trial Registry (clinicaltrials.gov, NCT03151876).

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“…[5][6][7][8][9][10][11] Despite the absence of high-level evidence, ASP-based regimens have been widely accepted as the standard of care in advanced-stage disease. [9][10][11][12][13][14][15][16][17][18] Given favorable outcomes with upfront radiotherapy for early-stage ENKTCL, adding chemotherapy to radiotherapy conferred survival benefit for intermediate-and high-risk patients but not for low-risk patients. 22,23 A variety of ASP-based or PLA-based regimens have been used as the appropriate CMT approach.…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…Various non-anthracycline-based regimens have been considered as a first-line option for patients with ENKTCL. 9,10,[13][14][15][16][17][18] For advanced-stage or refractory-relapsed patients, ASP-based regimens, such as SMILE (corticosteroid, MTX, ifosfamide, L-ASP, and etoposide), 9,10,13 Aspa-MetDex (L-ASP, MTX, and dexamethasone), 14 DDGP (GEM, pegaspargase, cisplatin, and dexamethasone), [15][16][17] and LVDP (L-ASP, etoposide, dexamethasone and cisplatin) 18 have improved patient survival outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Zheng

Yang

et al. 2021

ESMO Open

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Background: This study evaluated the survival benefit of asparaginase (ASP)-based versus non-ASP-based chemotherapy combined with radiotherapy in a real-world cohort of patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTCL). Patients and methods: We identified 376 patients who received combined radiotherapy with either ASP-based (ASP, platinum, and gemcitabine; n ¼ 286) or non-ASP-based (platinum and gemcitabine; n ¼ 90) regimens. The patients were stratified into low-, intermediate-, and high-risk groups using the early stage-adjusted nomogram-revised risk index. Overall survival (OS) and distant metastasis (DM)-free survival (DMFS) between the chemotherapy regimens were compared using inverse probability of treatment weighting (IPTW) and multivariable analyses. Results: ASP-based (versus non-ASP-based) regimens significantly improved 5-year OS (84.5% versus 73.2%, P ¼ 0.021) and DMFS (84.4% versus 74.5%, P ¼ 0.014) for intermediate-and high-risk patients, but not for low-risk patients in the setting of radiotherapy. Moreover, ASP-based regimens decreased DM, with a 5-year cumulative DM rate of 14.9% for ASP-based regimens compared with 25.1% (P ¼ 0.014) for non-ASP-based regimens. The survival benefit of ASP-based chemotherapy and radiotherapy remained consistent after adjusting the confounding variables using IPTW and multivariate analyses; additional sensitivity analyses confirmed these results. Conclusions: The findings provided support for ASP-based chemotherapy and radiotherapy as a first-line treatment strategy for intermediate-and high-risk early-stage ENKTCL.

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Trial of LVDP regimen (l-asparaginase, etoposide, dexamethasone, and cisplatin, followed by radiotherapy) as first-line treatment for newly diagnosed, stage III/IV extranodal natural killer/T cell lymphoma

Cited by 13 publications

References 37 publications

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

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

A new conditioning regimen with chidamide, cladribine, gemcitabine and busulfan significantly improve the outcome of high‐risk or relapsed/refractory non‐Hodgkin's lymphomas

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

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