1
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Zhang Y, Deng Y, Zou Q, Jing B, Cai P, Tian X, Yang Y, Li B, Liu F, Li Z, Liu Z, Feng S, Peng T, Dong Y, Wang X, Ruan G, He Y, Cui C, Li J, Luo X, Huang H, Chen H, Li S, Sun Y, Xie C, Wang L, Li C, Cai Q. Artificial intelligence for diagnosis and prognosis prediction of natural killer/T cell lymphoma using magnetic resonance imaging. Cell Rep Med 2024; 5:101551. [PMID: 38697104 PMCID: PMC11148767 DOI: 10.1016/j.xcrm.2024.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/05/2024] [Accepted: 04/11/2024] [Indexed: 05/04/2024]
Abstract
Accurate diagnosis and prognosis prediction are conducive to early intervention and improvement of medical care for natural killer/T cell lymphoma (NKTCL). Artificial intelligence (AI)-based systems are developed based on nasopharynx magnetic resonance imaging. The diagnostic systems achieve areas under the curve of 0.905-0.960 in detecting malignant nasopharyngeal lesions and distinguishing NKTCL from nasopharyngeal carcinoma in independent validation datasets. In comparison to human radiologists, the diagnostic systems show higher accuracies than resident radiologists and comparable ones to senior radiologists. The prognostic system shows promising performance in predicting survival outcomes of NKTCL and outperforms several clinical models. For patients with early-stage NKTCL, only the high-risk group benefits from early radiotherapy (hazard ratio = 0.414 vs. late radiotherapy; 95% confidence interval, 0.190-0.900, p = 0.022), while progression-free survival does not differ in the low-risk group. In conclusion, AI-based systems show potential in assisting accurate diagnosis and prognosis prediction and may contribute to therapeutic optimization for NKTCL.
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Affiliation(s)
- YuChen Zhang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - YiShu Deng
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Information Technology Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou 510006, P.R. China
| | - QiHua Zou
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - BingZhong Jing
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Information Technology Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
| | - PeiQiang Cai
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - XiaoPeng Tian
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - Yu Yang
- Department of Lymphadenoma and Head & Neck Medical Oncology, Fujian Provincial Cancer Hospital & Institute, Fuzhou, P.R. China
| | - BingZong Li
- Department of Hematology, The Second Affiliated Hospital of Suzhou University, Jiangsu, P.R. China
| | - Fang Liu
- Department of Pathology, The First People's Hospital of Foshan, Foshan, P.R. China
| | - ZhiHua Li
- Department of Oncology, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, P.R. China
| | - ZaiYi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, P.R. China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou 510080, P.R. China
| | - ShiTing Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, P.R. China
| | - TingSheng Peng
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, P.R. China
| | - YuJun Dong
- Department of Hematology, Peking University First Hospital, Beijing 100034, P.R. China
| | - XinYan Wang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - GuangYing Ruan
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Yun He
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - ChunYan Cui
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Jiao Li
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - Xiao Luo
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China
| | - HuiQiang Huang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - HaoHua Chen
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Information Technology Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China
| | - SongQi Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, P.R. China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China
| | - ChuanMiao Xie
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, P.R. China.
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China.
| | - ChaoFeng Li
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Information Technology Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China.
| | - QingQing Cai
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P.R. China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China.
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2
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Chaubard S, Marouf A, Lavergne D, Lemonnier F, Rossignol J, Clavert A, Gressin R, Cartron G, Waultier-Rascalou A, Vargaftig J, Salles G, Bachy E, Ghesquières H, Tournilhac O, Chauchet A, Le Gouill S, Damaj G, Fornecker LM, Sibon D, Obéric L, Michot JM, Gaulard P, Hermine O, Couronné L, Jaccard A. Efficacy of a short sandwich protocol, methotrexate, gemcitabine, L-asparaginase and dexamethasone chemotherapy combined with radiotherapy, in localised newly diagnosed NK/T-cell lymphoma: A French retrospective study. Br J Haematol 2023; 201:673-681. [PMID: 36799516 DOI: 10.1111/bjh.18689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
Extranodal NK/T-cell lymphoma, nasal type is a rare and aggressive form of lymphoma, historically associated with poor prognosis. We report here the results of a retrospective multi-centre study evaluating the efficacy of MGAD (methotrexate, gemcitabine, L-asparaginase and dexamethasone) regimen (two cycles) combined with 'sandwich' radiotherapy in 35 patients with localised newly diagnosed extranodal NK/T-cell lymphoma. Thirty-two patients (91%) reached complete remission. With a long median follow-up of 59.6 months, progression-free and overall survival at 2 and 5 years were 71%, 80% and 53%, 73%, respectively. Around one third of the patients experienced relapse within a median time of 14.5 months. Side-effects were manageable with grades 3-4 cytopenias, mucositis and infection in 50%, 24% and 21% of the cases, respectively. Monitoring of asparaginase activity was performed in 13 patients and showed inactivation of the drug in seven (54%) patients. Our results indicate that a short therapy by sandwich MGAD chemoradiotherapy is a tolerable and effective treatment option in localised newly diagnosed extranodal NK/T-cell lymphoma patients.
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Affiliation(s)
- Sammara Chaubard
- Hematology Department, Limoges University Hospital, Limoges, France
| | - Amira Marouf
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France
| | - David Lavergne
- Hematology Department, Limoges University Hospital, Limoges, France
| | - François Lemonnier
- Hematology Department, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, INSERM U955, Mondor Institute for Biomedical Research, Paris-Est Créteil University, Créteil, France
| | - Julien Rossignol
- Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Aline Clavert
- Hematology Department, Angers University Hospital, Angers, France
| | - Rémy Gressin
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | - Guillaume Cartron
- Hematology Department, University Hospital Center UMR-CNRS 5235, Montpellier, France
| | | | - Jacques Vargaftig
- Hematology Department, René Huguenin Hospital-Curie Institute, Saint-Cloud, France
| | - Gilles Salles
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Emmanuel Bachy
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Hervé Ghesquières
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Olivier Tournilhac
- Hematology Department, Clermont University Hospital of Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Adrien Chauchet
- Hematology Department, Jean Minjoz University Hospital, Besançon, France
| | - Steven Le Gouill
- Service d'Hématologie Clinique, Hôtel-Dieu, CHU Nantes, INSERM, CNRS, CRCINA Nantes, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Gandhi Damaj
- Hematology Institute, Caen University Hospital, Normandy University, Caen, France
| | | | - David Sibon
- Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucie Obéric
- Hematology Department, Toulouse-Oncopole University Cancer Institute (IUCT-O), Toulouse, France
| | - Jean-Marie Michot
- Gustave Roussy Institute, Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Villejuif, France
| | - Philippe Gaulard
- Pathology Department, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, INSERM U955, Mondor Institute for Biomedical Research, Paris-Est Créteil University, Créteil, France
| | - Olivier Hermine
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France.,Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucile Couronné
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France.,Laboratory of Onco-Hematology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Arnaud Jaccard
- Hematology Department, Limoges University Hospital, Limoges, France
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3
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Yan Z, Yao S, Wang Z, Zhou W, Yao Z, Liu Y. Treatment of extranodal NK/T-cell lymphoma: From past to future. Front Immunol 2023; 14:1088685. [PMID: 36825002 PMCID: PMC9941192 DOI: 10.3389/fimmu.2023.1088685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Extranodal NK/T-cell lymphoma (ENKTCL) is the most common subtype of T/NK-cell lymphoma in Asia and Latin America, but very rare in North American and Europe. Patient survival has improved significantly over the past two decades. However, standard treatment has not yet been established, although dozens of prospective trials have been conducted. To help understand how the treatment of ENKTCL has evolved in the past and what trends lie ahead, we have comprehensively reviewed the treatment of this aggressive malignancy, with a particular focus on neglected or unanswered issues, such as the optimal staging method, the best partner of asparaginase (Asp), the individualized administration of Asp, the preferred sequence of CT and RT and so on. Overall, the 5-year overall survival (OS) of patients with Ann Arbor stage I/II disease increased from < 50% in the early 20th century to > 80% in recent years, and the median OS of patients with Ann Arbor stage III/IV disease increased from < 1 year to more than 3 years. The improvement in patient survival is largely attributable to advances in radiation technology and the introduction of Asp and anti-PD-1/PD-L1 immunotherapy into practice. Radiotherapy is essential for patients with early-stage disease, while Asp-based chemotherapy (CT) and PD-1/PD-L1 inhibitors significantly improved the prognosis of patients with advanced-stage disease. ENKTCL management is trending toward simpler regimens, less toxicity, and higher efficacy. Novel drugs, such as manufactured T cells, monoclonal antibodies, and small molecule inhibitors, are being intensively investigated. Based on the fact that ENKTCL is highly resistant to cytotoxic drugs except Asp, and aggressive CT leads to higher toxicity rather than better outcomes, we recommend it is unnecessary to expend additional resources to compare different combinations of Asp with cytotoxic agents. Instead, more efforts should be made to optimize the use of Asp and immunotherapy to maximize efficacy and minimize toxicity, explore ways to overcome resistance to Asp and immunotherapy, identify novel treatment targets, and define subpopulations who may benefit more from specific treatments.
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Affiliation(s)
- Zheng Yan
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Shuna Yao
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Zhizhong Wang
- Department of Molecular Pathology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Wenping Zhou
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Zhihua Yao
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Yanyan Liu
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China
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4
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Qi F, Zhou W, Xie Y, Sun Y, Wu M, Chai Y, Chen B, Lin N, Liu W, Ding N, Li Y, Dong M, Song Y, Zhu J. Deep remission from induction chemotherapy predicts favorable long-term survivals in early stage extranodal nasal NK/T-cell lymphoma receiving sequential chemotherapy and radiation. Aging (Albany NY) 2022; 14:8729-8744. [DOI: 10.18632/aging.204355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Fei Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Wenyuan Zhou
- NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yan Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yan Sun
- Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Meng Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ningjing Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Ning Ding
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Mei Dong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
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5
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Qi F, Xie Y, Wang D, Chai Y, Chen B, Sun Y, Liu W, Qi S, Wei Y, Fang H, Zhao D, Gui L, Yang Y, Feng X, Ding N, Mi L, Shu S, Li Y, Song Y, Dong M, Zhu J. Comparison analysis of first-line asparaginase- versus non-asparaginase-based regimens for early-stage extranodal NK/T-cell lymphoma. Ann Hematol 2022; 101:2021-2034. [PMID: 35798977 DOI: 10.1007/s00277-022-04892-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 06/05/2022] [Indexed: 01/19/2023]
Abstract
The present study investigated the efficacy and toxicity profile of first-line asparaginase (ASP)-based versus non-ASP-based regimens in treating early-stage extranodal NK/T-cell lymphoma (ENKTCL) in non-anthracycline therapy era. This multi-center, real-world retrospective study consisted 305 newly diagnosed localized ENKTCL patients who were treated with sequential chemoradiation between 2010 and 2020 in China: 190 cases received ASP-based regimens and 115 cases received non-ASP-based regimens. Propensity score matching and multivariable analyses were used to compare survivals and toxicities between the two treatment groups. Non-ASP-based regimens achieved comparable survivals compared with ASP-based regimens in the entire cohort. The 5-year overall survival (OS), progression-free survival (PFS) rates were 84.7% and 73.5% for non-ASP-based regimens, and 87.7% (P=0.464) and 74.6% (P=0.702) for ASP-based regimens. The non-inferior survivals of non-ASP-based regimens were consistent after adjustment using PSM and multivariable analyses. However, survival benefits of ASP varied in different treatment modalities. Among patients receiving sequential chemotherapy and radiation (CT+RT±CT), ASP-based regimens achieved higher complete remission rate (54.3 vs. 34.5%, P=0.047) and more favorable survivals compared with non-ASP-based regimens (5-year OS, 87.0 vs. 69.0%, P=0.028). However, for patients receiving sequential radiation and chemotherapy (RT+CT), non-ASP-based regimens achieved comparable favorable survivals as ASP-based regimens. Besides, liver injury, malnutrition, and coagulative dysfunction were significantly more commonly documented in ASP-based regimens. These findings suggested that ASP was an effective agent in treating ENKTCL, especially among those receiving induction CT and RT. For patients who received upfront RT, non-ASP-based regimens might be a comparably effective and more tolerable treatment option.
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Affiliation(s)
- Fei Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yan Xie
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Dedao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yue Chai
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yan Sun
- Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Weiping Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuce Wei
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dan Zhao
- Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yong Yang
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaoli Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Ding
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Lan Mi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shaokun Shu
- Department of Biomedical Engineering, Peking University, Beijing, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yuqin Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Mei Dong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Jun Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China
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6
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The optimal timing of radiotherapy in the combination treatment of limited-stage extranodal natural killer/T-cell lymphoma, nasal type: an updated meta-analysis. Ann Hematol 2021; 100:2889-2900. [PMID: 34708280 DOI: 10.1007/s00277-021-04700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
This study was designed to explore the relative efficacy and toxicity of upfront radiotherapy (RT) and late RT in combination treatments for patients with limited-stage extranodal natural killer/T-cell lymphoma nasal type (LS-ENKTL). We searched for clinical trials in the PubMed database that compared upfront RT with late RT in the combined treatment of patients with LS-ENKTL. We systematically evaluated the differences in survival, treatment response, and treatment-related adverse events (AEs) between these two groups. Ten retrospective studies with a total of 1752 patients were included. Upfront RT significantly prolonged the overall survival (OS) and progression-free survival (PFS) of patients compared to late RT in combination with chemotherapy (CT) (HR = 0.72, 95% CI 0.59-0.88, P = 0.001 for OS; HR = 0.57, 95% CI 0.41-0.79, P = 0.0007 for PFS). The complete remission (CR) rate in the upfront RT group was superior to that in the late RT group (HR = 1.61, 95% CI 1.09-2.37, P = 0.02). Patients experienced similar local recurrence-free survival (LRFS), objective response rates (ORR), and toxicity between these two arms (P > 0.05 for all) in the analysis of each subgroup. The survival benefit of upfront RT was not correlated with the RT dose, concurrent chemoradiotherapy (CCRT) (or not), or the CT regimen (P > 0.05 for all). Without compromises in terms of toxicity, RT dose, and treatment modality, upfront RT can significantly benefit OS, PFS, and CR compared to late RT in combination treatment. These findings verified that the upfront RT regimen is more suitable for patients with LS-ENKTL.
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7
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Qi SN, Li YX, Specht L, Oguchi M, Tsang R, Ng A, Suh CO, Ricardi U, Mac Manus M, Dabaja B, Yahalom J. Modern Radiation Therapy for Extranodal Nasal-Type NK/T-cell Lymphoma: Risk-Adapted Therapy, Target Volume, and Dose Guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2021; 110:1064-1081. [PMID: 33581262 DOI: 10.1016/j.ijrobp.2021.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
In the multidisciplinary management of early-stage extranodal natural killer/T-cell lymphoma, nasal type (ENKTCL), with curative intent, radiation therapy is the most efficacious modality and is an essential component of a combined-modality regimen. In the past decade, utilization of upfront radiation therapy and non-anthracycline-based chemotherapy has improved treatment and prognosis. This guideline mainly addresses the heterogeneity of clinical features, principles of risk-adapted therapy, and the role and appropriate design of radiation therapy. Radiation therapy methods (including target volume definition, dose and delivery methods) are crucial for optimizing cure for patients with early-stage ENKTCL. The application of the principles of involved site radiation therapy in this lymphoma entity often leads to a more extended clinical target volume (CTV) than in other lymphoma types because it usually presents with primary tumor invasion, multifocal lesions, or extensive submucosal infiltration beyond the macroscopic disease. The CTV varies across different primary sites and is classified mainly into nasal, nonnasal upper aerodigestive tract (UADT), and extra-UADT entities. This review is a consensus of the International Lymphoma Radiation Oncology Group regarding the approach to radiation therapy, target-volume definition, optimal dose, and dose constraints in ENKTCL treatment.
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Affiliation(s)
- Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Masahiko Oguchi
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Richard Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Republic of Korea
| | - Umberto Ricardi
- Department of Radiation Oncology, University of Torino, Torino, Italy
| | - Michael Mac Manus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Bouthaina Dabaja
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
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8
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First-line non-anthracycline-based chemotherapy for extranodal nasal-type NK/T-cell lymphoma: a retrospective analysis from the CLCG. Blood Adv 2021; 4:3141-3153. [PMID: 32658985 DOI: 10.1182/bloodadvances.2020001852] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
The present study investigated the survival benefit of non-anthracycline (ANT)-based vs ANT-based regimens in a large-scale, real-world cohort of patients with extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTCL). Within the China Lymphoma Collaborative Group (CLCG) database (2000-2015), we identified 2560 newly diagnosed patients who received chemotherapy with or without radiotherapy. Propensity score matching (PSM) and multivariable analyses were used to compare overall survival (OS) and progression-free survival (PFS) between the 2 chemotherapy regimens. We explored the survival benefit of non-ANT-based regimens in patients with different treatments in early-stage disease and in risk-stratified subgroups. Non-ANT-based regimens significantly improved survivals compared with ANT-based regimens. The 5-year OS and PFS were 68.9% and 59.5% for non-ANT-based regimens compared with 57.5% and 44.5% for ANT-based regimens in the entire cohort. The clinical advantage of non-ANT-based regimens was substantial across the subgroups examined, regardless of stage and risk-stratified subgroup, and remained significant in early-stage patients who received radiotherapy. The survival benefits of non-ANT-based regimens were consistent after adjustment using multivariable and PSM analyses. These findings provide additional evidence supporting non-ANT-based regimens as a first-line treatment of patients with ENKTCL.
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9
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Li J, Li Y, Zeng R, Lin J, Zhong M, Liu X, He Y, He J, Ouyang Z, Huang L, Xiao L, Zhou H. Optimal Courses of Chemotherapy Combined with Radiotherapy for Low-Risk Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type: A Propensity Score Matching Analysis. Ther Clin Risk Manag 2020; 16:1151-1163. [PMID: 33299317 PMCID: PMC7721000 DOI: 10.2147/tcrm.s254246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose This retrospective study compared effectiveness between ≤4 cycles and ≥5 cycles of L-asparaginase/pegaspargase-based chemoradiation in newly diagnosed low-risk extranodal natural killer/T-cell lymphoma (ENKTL), nasal type classified according to the Prognostic Index of Natural Killer (PINK) lymphoma model. Patients and Methods Patients were categorized into ≤4-cycle (2–4 chemotherapy cycles, n = 166) and ≥5-cycle groups (5–6 cycles, n = 86). Propensity score matching analysis was used to reduce potential confounding bias between the two groups. Treatment responses, adverse events, and survival outcomes between the two groups were analyzed. Results No matter before or after matching (65 in the ≤4-cycle group, 65 in the ≥5-cycle group), response rates and survival outcomes were similar between the ≤4-cycle and ≥5-cycle groups. Incidences of grade 1–2 anemia and transaminase elevation were higher in the ≥5-cycle group. After matching, for stage IE disease, there were no differences in response rates and survival outcomes between the two groups. For stage IIE disease, the complete response rate was higher in the ≥5-cycle group (72.4% vs 92.6%, p = 0.049), and the 3-year overall survival (65.5% vs 85.2%, p = 0.024) and 3-year progression-free survival (58.6% vs 81.5%, p = 0.027) rates were significantly extended in the ≥5-cycle group. Conclusion When chemoradiotherapy strategies with L-asparaginase/pegaspargase-based regimens are applied to modern low-risk ENKTL patients classified according to the PINK model, it may be better to moderately extend chemotherapy courses in patients with stage IIE disease.
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Affiliation(s)
- Jin Li
- Department of Comprehensive Chemotherapy/Daytime Chemotherapy, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Yajun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Ruolan Zeng
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Jingguan Lin
- Department of Comprehensive Chemotherapy/Daytime Chemotherapy, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Meizuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yizi He
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Junqiao He
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Zhou Ouyang
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Lijun Huang
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
| | - Ling Xiao
- Department of Histology and Embryology, School of Basic Medical Science, Central South University, Changsha, Hunan, People's Republic of China
| | - Hui Zhou
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, People's Republic of China
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10
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Zhang L, Wang Y, Li X, Li L, Wang X, Sun Z, Wu J, Fu X, Zhang X, Yu H, Wang G, Chang Y, Yan J, Zhou Z, Wu X, Nan F, Li W, Zhang M. Radiotherapy vs sequential pegaspargase, gemcitabine, cisplatin and dexamethasone and radiotherapy in newly diagnosed early natural killer/T-cell lymphoma: A randomized, controlled, open-label, multicenter study. Int J Cancer 2020; 148:1470-1477. [PMID: 33034052 DOI: 10.1002/ijc.33329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/10/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
To compare the efficacy and safety of radiotherapy (RT) and chemotherapy of pegaspargase, gemcitabine, cisplatin and dexamethasone (DDGP) combined with RT in newly diagnosed stage I-II natural killer/T-cell lymphoma (NKTL), we designed a randomized, controlled, open-label, multicenter clinical trial. Data from 65 stage I-II NKTL patients whose diagnoses were confirmed using immunohistochemistry were enrolled from January 2011 to December 2013 in the First Affiliated Hospital of Zhengzhou University. Patients were randomly divided into the RT group (n = 35) and the DDGP combined with RT group (n = 30). There was a difference between the Eastern Cooperative Oncology Group (ECOG) score in the two arms (P = .013). The complete response rate (CRR) and objective response rate (ORR) of DDGP combined with RT group were superior to those in the RT group (CRR: 73.3% vs 48.6%; ORR: 83.3% vs 60.0%, respectively). The 5-year progression-free survival (PFS) rate and overall survival (OS) rate in the DDGP combined with RT group were higher than those in the RT group (82.9% vs 56.5% for PFS, P = .023; 85.7% vs 60.4% for OS, P = .040), and treatment methods and lactate dehydrogenase were independent risk factors. Myelosuppression (P < .001), gastrointestinal reactions (P < .001), abnormal liver function (P = .007), coagulation abnormalities (P < .001) and baldness (P < .001) were more likely to occur in the DDGP combined with RT group. In conclusion, DDGP combined with radiotherapy obviously obtained great efficacy and prolonged the survival time of patients, also the side effects were mild for stage I-II NKTL. This trial was registered at https://register.clinicaltrials.gov as #NCT01501136.
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Affiliation(s)
- Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Yan Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xinhua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhenchang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jingjing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xiaorui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Hui Yu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Guannan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Jiaqin Yan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Zhiyuan Zhou
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Feifei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University: Lymphoma Diagnosed and Treatment Center of Henan Province, Zhengzhou, Henan, China
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11
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Qi S, Yang Y, Zhang Y, Huang H, Wang Y, He X, Zhang L, Wu G, Qu B, Qian L, Hou X, Zhang F, Qiao X, Wang H, Li G, Zhu Y, Cao J, Wu J, Wu T, Zhu S, Shi M, Xu L, Yuan Z, Su H, Song Y, Zhu J, Hu C, Li Y. 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. Am J Hematol 2020; 95:1047-1056. [PMID: 32449800 DOI: 10.1002/ajh.25878] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/17/2022]
Abstract
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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Affiliation(s)
- Shu‐Nan Qi
- Department of Radiation Oncology National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing China
| | - Yong Yang
- Department of Radiation Oncology National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing China
| | - Yu‐Jing Zhang
- Department of Radiation Oncology State Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine Guangzhou China
| | - Hui‐Qiang Huang
- Department of Medical Oncology Sun Yat‐sen University Cancer Center China
| | - Ying Wang
- Department of Radiation Oncology Chongqing University Cancer Hospital & Chongqing Cancer Hospital Chongqing China
| | - Xia He
- Department of Radiation Oncology Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research Nanjing China
| | - Li‐Ling Zhang
- Department of Oncology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
| | - Gang Wu
- Department of Oncology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan China
| | - Bao‐Lin Qu
- Department of Radiation Oncology The General Hospital of Chinese People's Liberation Army Beijing China
| | - Li‐Ting Qian
- Department of Radiation Oncology The Affiliated Provincial Hospital of Anhui Medical University Hefei China
| | - Xiao‐Rong Hou
- Department of Radiation Oncology Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing China
| | - Fu‐Quan Zhang
- Department of Radiation Oncology Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing China
| | - Xue‐Ying Qiao
- Department of Radiation Oncology The Fourth Hospital of Hebei Medical University Shijiazhuang China
| | - Hua Wang
- Department of Radiation Oncology Second Affiliated Hospital of Nanchang University Nanchang China
| | - Gao‐Feng Li
- Department of Radiation Oncology Beijing Hospital, National Geriatric Medical Center Beijing China
| | - Yuan Zhu
- Department of Radiation Oncology Zhejiang Cancer Hospital, Hangzhou Zhejiang China
| | - Jian‐Zhong Cao
- Department of Radiation Oncology Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University Taiyuan China
| | - Jun‐Xin Wu
- Department of Radiation Oncology Fujian Provincial Cancer Hospital Fuzhou China
| | - Tao Wu
- Department of Radiation Oncology Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital Guiyang China
| | - Su‐Yu Zhu
- Department of Radiation Oncology Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine Changsha China
| | - Mei Shi
- Department of Radiation Oncology Xijing Hospital of Fourth Military Medical University Xi'an China
| | - Li‐Ming Xu
- Department of Radiation Oncology Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Tianjin China
| | - Zhi‐Yong Yuan
- Department of Radiation Oncology Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer Tianjin China
| | - Hang Su
- Department of Oncology The Fifth Medical Center of PLA General Hospital Beijing China
| | - Yu‐Qin Song
- Department of Medical Oncology Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute Beijing China
| | - Jun Zhu
- Department of Medical Oncology Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute Beijing China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Ye‐Xiong Li
- Department of Radiation Oncology National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC) Beijing China
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12
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Qi F, Chen B, Wang J, Lin X, Qi S, Yang J, Zhou S, Wang S, Gui L, Fang H, Liu P, Song Y, Yang S, Li Y, Dong M. Upfront radiation is essential for high-risk early-stage extranodal NK/T-cell lymphoma, nasal type: comparison of two sequential treatment modalities combining radiotherapy and GDP (gemcitabine, dexamethasone, and cisplatin) in the modern era. Leuk Lymphoma 2019; 60:2679-2688. [PMID: 31298062 DOI: 10.1080/10428194.2019.1599111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Early/upfront radiation was associated with improved survivals compared with late radiation for early-stage NK/T-cell lymphoma (NKTCL) in the old era when anthracycline-base chemotherapy (CT) prevailed. However, in the modern era of effective l-asparaginase/gemcitabine-based CT, the optimal timing of radiation is unclear. In this study, 75 patients with newly diagnosed NKTCL, who were treated with combined involved-field intensity-modulated radiotherapy and GDP (gemcitabine, dexamethasone, and cisplatin) were retrospectively reviewed, including 45 from the RT + CT group and 30 from the CT + RT ± CT group. Compared with CT + RT ± CT, RT + CT sequence achieved superior progression-free survival (5-year PFS: 81.6% vs. 56.0%, p = .017) and locoregional control (LRC) (90.8% vs. 66.9%; p = .020). Responses, overall survivals or adverse event incidences did not differ across the groups. Upfront RT was a powerful prognostic variable for favorable PFS (HR 0.302; 95% CI: 0.125-0.729; p = .008). It indicated that upfront RT administration remains vital in enhancing LRC and survival for localized NKTCL in the modern era.
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Affiliation(s)
- Fei Qi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Wang
- Department of Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinyi Lin
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shunan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianliang Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengyu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shulian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Gui
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Liu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongwen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yexiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei Dong
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Tian S, Li R, Wang T, Wang S, Tao R, Hu X, Ding H. Gemcitabine, dexamethasone, and cisplatin (GDP) chemotherapy with sandwiched radiotherapy in the treatment of newly diagnosed stage IE/IIE extranodal natural killer/T-cell lymphoma, nasal type. Cancer Med 2019; 8:3349-3358. [PMID: 31050212 PMCID: PMC6601591 DOI: 10.1002/cam4.2214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/12/2019] [Accepted: 04/13/2019] [Indexed: 12/25/2022] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL), nasal-type is a rare but highly aggressive disease with poor prognosis. Optimal treatment strategies for newly diagnosed localized ENKL have not been fully defined. Here we retrospectively analyzed 72 patients with newly diagnosed stage IE/IIE ENKL treated with gemcitabine, dexamethasone, and cisplatin (GDP) regimen chemotherapy with sandwiched radiotherapy in our department between May 2012 and September 2014. After 2 cycles of GDP induction chemotherapy, the complete response rate (CRR) and overall response rate (ORR) were 30.6% (22/72) and 91.7% (66/72). After whole treatment completion, the CRR and ORR were 81.9% (59/72) and 91.7% (66/72), respectively. With a median follow-up of 57.8 months (Interquartile Range 54.0-64.5 months), the 5-year progression-free survival rate was 70.9% (95% CI, 60.1% to 81.7%), and the 5-year overall survival rate was 72.0% (95% CI, 61.6% to 82.4%), respectively. Patients with CRR after treatment had better prognosis than their counterparts. The major adverse events were myelosuppression, liver dysfunction, gemcitabine-related skin rash, and digestive tract toxicities. Grade 3 to 4 neutropenia and thrombocytopenia were 18.0% (13/72) and 15.3% (11/72), respectively. No treatment related deaths were observed. It is concluded that the GDP regimen with sandwiched radiotherapy was an effective and well-tolerated treatment for newly diagnosed stage IE/IIE ENKL, nasal-type.
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Affiliation(s)
- Shu Tian
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
- Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Ruichen Li
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Tian Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Shengzi Wang
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
| | - Rong Tao
- Department of HematologyXinhua Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xichun Hu
- Department of Medical OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Hao Ding
- Department of Radiation Oncology, Eye Ear Nose and Throat HospitalFudan UniversityShanghaiChina
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14
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Liu X, Wu T, Zhu SY, Shi M, Su H, Wang Y, He X, Xu LM, Yuan ZY, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Zhang YJ, Zhu Y, Cao JZ, Lan SM, Wu JX, Qi SN, Yang Y, Li YX. Risk-Dependent Conditional Survival and Failure Hazard After Radiotherapy for Early-Stage Extranodal Natural Killer/T-Cell Lymphoma. JAMA Netw Open 2019; 2:e190194. [PMID: 30821826 PMCID: PMC6484659 DOI: 10.1001/jamanetworkopen.2019.0194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Prognosis of early-stage extranodal natural killer/T-cell lymphoma (NKTCL) is usually estimated and stratified at diagnosis, but how the prognosis actually evolves over time for patients who survived after curative treatment is unknown. OBJECTIVE To assess conditional survival and failure hazard over time based on risk categories, previous survival, and treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study reviewed the clinical data of 2015 patients with early-stage NKTCL treated with radiotherapy identified from the China Lymphoma Collaborative Group multicenter database between January 1, 2000, and December 31, 2015. Patients were stratified into low-, intermediate- and high-risk groups according to a previously established prognostic model. Median follow-up was 61 months for surviving patients. Data analysis was performed from December 1, 2017, to January 30, 2018. EXPOSURES All patients received radiotherapy with or without chemotherapy. MAIN OUTCOMES AND MEASURES Conditional survival defined as the survival probability, given patients have survived for a defined time, and annual hazard rates defined as yearly event rate. RESULTS A total of 2015 patients were included in the study (mean [SD] age, 43.3 [14.6] years; 1414 [70.2%] male); 1628 patients (80.8%) received radiotherapy with chemotherapy, and 387 (19.2%) received radiotherapy without chemotherapy. The 5-year survival rates increased from 69.1% (95% CI, 66.6%-71.4%) at treatment to 85.3% (95% CI, 81.7%-88.2%) at year 3 for conditional overall survival and from 60.9% (95% CI, 58.3%-63.3%) at treatment to 84.4% (95% CI, 80.6%-87.6%) at year 3 for conditional failure-free survival. The annual hazards decreased from 13.7% (95% CI, 13.0%-14.3%) for death and 22.1% (95% CI, 21.0%-23.1%) for failure at treatment to less than 5% after 3 years (death: range, 0%-3.9% [95% CI, 3.7%-4.2%]; failure: 1.2% [95% CI, 1.0%-1.4%] to 4.2% [95% CI 3.9%-4.6%]). Intermediate-risk (11.4% [95% CI, 10.5%-12.3%]) and high-risk (21.6% [95% CI, 20.0%-23.2%]) patients had initially higher but significantly decreased death hazards after 3 years (<6%, range: 0%-5.9% [95% CI, 5.2%-6.7%]), whereas low-risk patients maintained a constantly lower death hazard of less than 5% (range, 0%-4.8%; 95% CI, 4.4%-5.3%). In high-risk patients, radiotherapy combined with non-anthracycline-based regimens were associated with higher conditional overall survival before year 3 compared with anthracycline-based regimens (hazard ratio [HR] for death, 1.49; 95% CI, 1.13-1.95; P = .004 at treatment; HR, 1.60; 95% CI, 1.07-2.39; P = .02 at 1 year; and HR, 1.77; 95% CI, 0.94-3.33; P = .07 at 2 years) or radiotherapy alone (HR, 2.42; 95% CI, 1.73-3.39; P < .001 at treatment; HR, 1.82; 95% CI, 1.05-3.17; P = .03 at 1 year; and HR, 2.69; 95% CI, 1.23-5.90; P = .01 at 2 years). CONCLUSIONS AND RELEVANCE The survival probability increased and the hazards of failure decreased in a risk-dependent manner among patients with early NKTCL after radiotherapy. These dynamic data appear to provide accurate information on disease processes and continual survival expectations and may help researchers design additional prospective clinical trials and formulate risk-adapted therapies and surveillance strategies.
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Affiliation(s)
- Xin Liu
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Tao Wu
- Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Su-Yu Zhu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan, People’s Republic of China
| | - Mei Shi
- Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People’s Republic of China
| | - Hang Su
- 307 Hospital, Academy of Military Medical Science, Beijing, People’s Republic of China
| | - Ying Wang
- Chongqing Cancer Hospital & Cancer Institute, Chongqing, People’s Republic of China
| | - Xia He
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, People’s Republic of China
| | - Li-Ming Xu
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Zhi-Yong Yuan
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China
| | - Li-Ling Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Bao-Lin Qu
- The General Hospital of Chinese People's Liberation Army, Beijing, People’s Republic of China
| | - Li-Ting Qian
- The Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Xiao-Rong Hou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Fu-Quan Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yu-Jing Zhang
- Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
| | - Yuan Zhu
- Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Jian-Zhong Cao
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Sheng-Min Lan
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jun-Xin Wu
- Fujian Provincial Cancer Hospital, Fuzhou, Fujian, People’s Republic of China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology, Beijing, People’s Republic of China
- Department of Radiation Oncology, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Center for Cancer Precision Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, People’s Republic of China
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Phase 2 Study of First-line Intensity Modulated Radiation Therapy Followed by Gemcitabine, Dexamethasone, and Cisplatin for High-Risk, Early Stage Extranodal Nasal-Type NK/T-Cell Lymphoma: The GREEN Study. Int J Radiat Oncol Biol Phys 2018; 102:61-70. [DOI: 10.1016/j.ijrobp.2018.05.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 12/13/2022]
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16
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Hu S, Zhou D, Zhang W. The optimal timing of radiotherapy in the combined modality therapy for limited-stage extranodal NK/T cell lymphoma (ENKTL): a systematic review and meta-analysis. Ann Hematol 2018; 97:2279-2287. [PMID: 30128904 DOI: 10.1007/s00277-018-3479-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
The optimal timing and sequencing of radiotherapy (RT) and chemotherapy (CT) in the treatment of limited-stage extranodal NK/T cell lymphoma (LS-ENKTL) has not been elucidated. The aim of this meta-analysis was to evaluate whether the timing of RT in relation to CT affects the survival of patients with LS-ENKTL. We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov , and relevant meeting abstract databases from inception through April 2018 without age or language restrictions. Studies comparing upfront RT plus CT with induction CT followed by RT in patients with LS-ENTKL were eligible for inclusion. Seven studies with 1593 patients were included, and all were retrospective cohort studies. Compared with induction CT followed by RT, upfront RT significantly improved OS of patients with LS-ENTKL (HR = 0.70, 95%CI 0.55-0.88, P = 0.002), with no evidence of heterogeneity across studies (I2 = 0%). In subgroup analyses, the beneficial effect of upfront RT on survival did not differ significantly between subgroups of studies with different types of chemotherapy regimens (anthracycline-based or non-anthracycline-based), the administration of concurrent chemoradiotherapy or not, and different median doses of RT (≥ 45 or < 45 Gy). These results suggest that upfront RT plus CT confers survival advantage over induction CT followed by RT for the treatment of LS-ENTKL, and this survival advantage is not significantly affected by the types of CT regimens or timing of CT. Given the retrospective nature of included studies, these results should be interpreted with caution in clinical practice.
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Affiliation(s)
- Shaoxuan Hu
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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17
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Deng XW, Wu JX, Wu T, Zhu SY, Shi M, Su H, Wang Y, He X, Xu LM, Yuan ZY, Zhang LL, Wu G, Qu BL, Qian LT, Hou XR, Zhang FQ, Zhang YJ, Zhu Y, Cao JZ, Lan SM, Dong M, Qi SN, Yang Y, Li YX. Radiotherapy is essential after complete response to asparaginase-containing chemotherapy in early-stage extranodal nasal-type NK/T-cell lymphoma: A multicenter study from the China Lymphoma Collaborative Group (CLCG). Radiother Oncol 2018; 129:3-9. [PMID: 29739712 DOI: 10.1016/j.radonc.2018.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/20/2018] [Accepted: 04/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to clarify the benefit of radiotherapy (RT) in patients with early-stage extranodal NK/T-cell lymphoma (NKTCL) who achieve a complete response (CR) after asparaginase-containing chemotherapy (CT). PATIENTS AND METHODS Of 240 patients achieved a CR after asparaginase-containing CT, 202 patients received additional RT (CT + RT), and 38 patients did not (CT alone). RESULTS Compared to CT alone, CT + RT significantly improved overall survival (OS), disease-free survival (DFS) and locoregional control (LRC). The 5-year OS, DFS and LRC rates were 84.9%, 76.2% and 84.9% for CT + RT, compared to 58.9% (P = 0.006), 43.6% (P = 0.001) and 62.1% (P = 0.026) for CT alone. The 5-year cumulative disease recurrence rate was 18.8% for CT + RT compared to 46.9% (P = 0.003) for CT alone. High-dose RT (≥50 Gy) significantly decreased the risk of locoregional recurrence. The 5-year cumulative locoregional failure rate was 35.5% for patients receiving <50 Gy compared to 8.8% for patients receiving ≥50 Gy (P = 0.028). CONCLUSIONS For patients with early-stage NKTCL who achieve a CR after asparaginase-containing CT, omission of RT results in frequent locoregional recurrence and a poor prognosis; RT is essential to improve locoregional control and survival.
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Affiliation(s)
- Xiu-Wen Deng
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, PR China
| | - Jun-Xin Wu
- Fujian Provincial Cancer Hospital, Fuzhou, PR China
| | - Tao Wu
- Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, PR China
| | - Su-Yu Zhu
- Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, PR China
| | - Mei Shi
- Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Hang Su
- 307 Hospital, Academy of Military Medical Science, Beijing, PR China
| | - Ying Wang
- Chongqing Cancer Hospital & Cancer Institute, PR China
| | - Xia He
- Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, PR China
| | - Li-Ming Xu
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, PR China
| | - Zhi-Yong Yuan
- Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, PR China
| | - Li-Ling Zhang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Gang Wu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Bao-Lin Qu
- The General Hospital of Chinese People's Liberation Army, Beijing, PR China
| | - Li-Ting Qian
- The Affiliated Provincial Hospital of Anhui Medical University, Hefei, PR China
| | - Xiao-Rong Hou
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Fu-Quan Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, PR China
| | - Yu-Jing Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, PR China
| | - Yuan Zhu
- Zhejiang Cancer Hospital, Hangzhou, PR China
| | - Jian-Zhong Cao
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, PR China
| | - Sheng-Min Lan
- Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, PR China
| | - Mei Dong
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, PR China
| | - Shu-Nan Qi
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, PR China
| | - Yong Yang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, PR China
| | - Ye-Xiong Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), National Institute of Biological Sciences, Collaborative Innovation Center for Cancer Medicine, Beijing, PR China.
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18
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Li J, Li Y, Zhong M, Liu X, Song Y, Li J, Li K, Yi P. Short-Course Versus Long-Course Chemoradiotherapy for Stage IE-IIE Extranodal Natural Killer/T cell Lymphoma, Nasal Type: A Multicenter Retrospective Study. Med Sci Monit 2018; 24:2683-2692. [PMID: 29712887 PMCID: PMC5951025 DOI: 10.12659/msm.909506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background This study compared clinical outcomes and adverse events between L-asparaginase/pegaspargase-based short-course and long-course chemoradiotherapy in newly diagnosed stage IE–IIE extranodal natural killer/T cell lymphoma, nasal type (ENKTL). Material/Methods Patients were categorized into a short-course (2–4 chemotherapy cycles, median: 4, n=153) and long-course group (5–6 cycles, median: 6, n=83). The chemotherapy regimens included GELOX, SMILE, and VLP. The radiotherapy dose was 40–63 Gy (median: 55 Gy). Adverse events, treatment responses, and survival outcomes between the 2 groups were compared. Results Ann Arbor stage IIE and short-course chemotherapy adversely affected overall survival (OS). Ann Arbor stage IE favorably affected progression-free survival (PFS). Grade 3–4 hematological toxicities were higher in the long-course group (25.3% vs. 14.4%, p=0.038). Ann Arbor stage was the single different clinical feature between the 2 groups, and independently affected survival outcomes. In subgroup analysis of stage IE, there was no difference in response rates and survival outcomes between the 2 groups. In subgroup analysis of stage IIE, the recurrence and death rates were significantly lower in the long-course group (6.1% vs. 23.2%, p=0.015; 12.2% vs. 39.3%, p=0.002; respectively), and the 3-year OS and PFS rates were much longer in the long-course group (87.8% vs. 62.5%, p<0.001; 83.7% vs. 57.1%, p=0.001; respectively). Conclusions When radiotherapy was combined with L-asparaginase/pegaspargase-based chemotherapy to treat early-stage ENKTL patients, 2–4 cycles of chemotherapy might be sufficient for stage IE patients, while stage IIE patients might require 5+ cycles.
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Affiliation(s)
- Jin Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Yajun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, Hunan, China (mainland)
| | - Meizuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Xianling Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Yinghui Song
- Department of Oncology, Changsha Central Hospital, Changsha, Hunan, China (mainland)
| | - Jiwei Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Kunlun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
| | - Pingyong Yi
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China (mainland)
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19
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Li JW, Li YJ, Zhong MZ, Liu XL, Li J, Li KL, Liu XY, Zhou F, OuYang Z, Sun ZY, Huang LJ, He JQ, Zhou H, Yi PY. Efficacy and tolerance of GELOXD/P-GEMOXD in newly diagnosed nasal-type extranodal NK/T-cell lymphoma: A multicenter retrospective study. Eur J Haematol 2018; 100:247-256. [PMID: 29194798 DOI: 10.1111/ejh.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Ji-Wei Li
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Ya-Jun Li
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Mei-Zuo Zhong
- Department of Oncology; Xiangya Hospital; Central South University; Changsha Hunan China
| | - Xian-Ling Liu
- Cancer Center of the Second Xiangya Hospital; Central South University; Changsha Hunan China
| | - Jin Li
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Kun-Lun Li
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Xi-Yu Liu
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Fang Zhou
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Zhou OuYang
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Zhong-Yi Sun
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Li-Jun Huang
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Jun-Qiao He
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Hui Zhou
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
| | - Ping-Yong Yi
- Department of Lymphoma and Hematology; Hunan Cancer Hospital; Changsha Hunan China
- The Affiliated Cancer Hospital of Xiangya School of Medicine; Central South University; Changsha Hunan China
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20
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Pokrovsky VS, Vinnikov D. L-Asparaginase for newly diagnosed extra-nodal NK/T-cell lymphoma: systematic review and meta-analysis. Expert Rev Anticancer Ther 2017. [PMID: 28621166 DOI: 10.1080/14737140.2017.1344100] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this review was to compare the efficacy of asparaginase (ASP)-containing vs ASP-absent regimens in the first-line treatment of ENKTL patients. METHODS The PRISMA protocol was used to search PubMed and Embase for both controlled and uncontrolled studies of ASP or alternative chemotherapy (CT) for newly diagnosed ENKTL, published in English by March 2017. The regimens were compared to calculate relative risk (RR) with 95% confidence interval (CI) of the overall response rate (ORR), complete response (CR) or partial response (PR). RESULTS Out of 38 studies included, eight were controlled trials, with the pooled RR of ORR in stage I-II 1.54 (95% CI 1.34-1.77); stage I-IV 1.34 (95% CI 1.09-1.64). In stage III-IV CT combined with radiotherapy (RT), RR of ORR was 2.30 (95% CI 1.66-3.18). ASP was also superior in achieving CR. When all single arms combined, RR of ORR after CT with ASP was 1.52 (95% CI 1.38-1.67) in stage I-II (15 studies); 1.44 (95% CI 1.32-1.57) in all stages (29 studies); 1.31 (95% CI 1.24-1.38) and 1.66 (95% CI 1.18-2.34) in stages I-II and III-IV combined with RT, correspondingly. CONCLUSIONS ASP-based CT significantly improved ORR and CR in patients with newly diagnosed both early-stage and advanced-stage ENKTL.
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Affiliation(s)
- Vadim S Pokrovsky
- a Department of Combined Therapy , N.N. Blokhin Cancer Research Center , Moscow , Russian Federation.,b Medical Faculty , Peoples' Friendship University of Russia (RUDN University) , Moscow , Russian Federation
| | - Denis Vinnikov
- c School of Public Health , Al-Farabi Kazakh National University , Almaty , Kazakhstan.,d Biological Institute , National Research Tomsk State University , Tomsk , Russian Federation
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21
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Vargo JA, Patel A, Glaser SM, Balasubramani GK, Farah RJ, Marks SM, Beriwal S. The impact of the omission or inadequate dosing of radiotherapy in extranodal natural killer T-cell lymphoma, nasal type, in the United States. Cancer 2017; 123:3176-3185. [DOI: 10.1002/cncr.30697] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/30/2017] [Accepted: 02/18/2017] [Indexed: 02/02/2023]
Affiliation(s)
- John A. Vargo
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Arisha Patel
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Scott M. Glaser
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Goundappa K. Balasubramani
- Epidemiology Data Center; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health; Pittsburgh Pennsylvania
| | - Rafic J. Farah
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Stanley M. Marks
- Division of Hematology and Oncology; Department of Medicine, University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
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22
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Li YY, Feng LL, Niu SQ, Wang HY, Zhang LL, Wang L, Xia ZJ, Huang HQ, Xia YF, Zhang YJ, Wang XC. Radiotherapy improves survival in early stage extranodal natural killer/T cell lymphoma patients receiving asparaginase-based chemotherapy. Oncotarget 2017; 8:11480-11488. [PMID: 28002792 PMCID: PMC5355279 DOI: 10.18632/oncotarget.14006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/23/2016] [Indexed: 11/25/2022] Open
Abstract
This study retrospectively investigated asparaginase-based chemotherapy treatment outcomes with or without radiotherapy in 143 patients with stage IE-IIE extranodal natural killer/T cell lymphoma (ENKTCL). All patients received a median of three cycles of asparaginase-based chemotherapy, while 121 patients received radiotherapy following the chemotherapy. The complete remission (CR) rate for all patients post-chemotherapy was 58.7%, and rose to 73.4% by the end of treatment. Patients who received radiotherapy achieved better survival outcomes than those who did not (89.7% vs. 49.0% for 2-year overall survival (OS), P<0.001; 86.8% vs. 37.4% for 2-year progression-free survival (PFS), P<0.001). Additionally, even patients who achieved CR post-chemotherapy exhibited differential survival rates with or without radiotherapy (90.8% vs. 60% for 2-year OS, P=0.006; 86.1% vs. 60% for 2-year PFS, P=0.044). Multivariate analysis revealed that radiotherapy was an independent factor favoring OS (HR=0.098, 95%CI=0.031-0.314, P=0.001) and PFS (HR=0.156, 95%CI=0.062-0.396, P=0.001). Thus, radiotherapy is recommended for stage IE-IIE ENKTCL patients treated with asparaginase-based chemotherapy, even in cases of CR following chemotherapy.
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Affiliation(s)
- Yi-Yang Li
- Department of Oncology, the First affiliated Hospital of Guangdong Pharmaceutical University, Guangdong 510080, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Ling-Ling Feng
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Shao-Qing Niu
- Department of Radiation Oncology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Han-Yu Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Lu-Lu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Liang Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 5100600, People's Republic of China
| | - Zhong-Jun Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 5100600, People's Republic of China
| | - Hui-Qiang Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Yu-Jing Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, People's Republic of China
| | - Xi-Cheng Wang
- Department of Oncology, the First affiliated Hospital of Guangdong Pharmaceutical University, Guangdong 510080, People's Republic of China
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Huang L, Yuan B, Wu H, Chu H, Liu Y, Wu S, Li H, Lu H, Chen H. Comparative Study of L-Asparaginase-Based LOP Regimen Over CHOP Regimen Before Radiotherapy for Stage IIE Extranodal Nasal Type NK/T Cell Lymphoma: A Study of 2 Centers. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:152-158. [PMID: 28215935 DOI: 10.1016/j.clml.2016.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/24/2016] [Accepted: 12/29/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this study we evaluated the efficacy of an L-asparaginase-based LOP (L-asparaginase, vincristine, and dexamethasone) regimen in extranodal Natural Killer (NK)/T-cell lymphoma (ENKTL) patients in the Guizhou province of China. PATIENTS AND METHODS Forty-eight patients were treated with the LOP (L-asparaginase, vincristine and dexamethasone) regimen chemotherapy (CT) and 32 patients with the CHOP (cyclophosphamide, tetrahydropyanyl adriamycin, vincristine, and prednisone) regimen. These patients then received involved-field radiotherapy (RT) with the doses of DT = 49-59 Gy. RESULTS A significant improvement of clinical end points with the LOP regimen was noticed compared with the CHOP regimen: 33 (68.8%) versus 16 (50.0%) for complete responses; 10 (20.8%) versus 5 (15.6%) for partial responses. There were statistical differences in objective response rates (43 [89.6%] for LOP vs. 21 [65.6%] for CHOP; P = .009), 3 years of overall survival (42 [87.5%] for LOP vs. 20 [62.5%] for CHOP; P = .006) and progression-free survival (32 [79.2%] for LOP vs. 16 [50.0%] for CHOP; P = .007). CONCLUSION The results showed that the LOP regimen is safe and much more efficient than the CHOP regimen for stage IIE ENKTL patients. They indicate that the LOP regimen is a satisfying alternative protocol among the other L-asparaginase-based regimens reported so far, such as SMILE (dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide), GELOX (gemcitabine, oxaliplatin, and L-asparaginase), CHOP-L, and sandwich (CT, then RT, then CT).
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Affiliation(s)
- Limin Huang
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Bin Yuan
- Department of Hematology, Guizhou Cancer Hospital, Guiyang, Guizhou, China.
| | - Haixia Wu
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Hongliang Chu
- Department of Hematology, Guizhou Cancer Hospital, Guiyang, Guizhou, China
| | - Yayun Liu
- Department of Hematology, Guizhou Cancer Hospital, Guiyang, Guizhou, China
| | - Shuang Wu
- INSERM UMR_S 1165/Paris 7, Hôpital Saint Louis, Paris, France
| | - Hong Li
- INSERM UMR_S 1165/Paris 7, Hôpital Saint Louis, Paris, France
| | - He Lu
- INSERM UMR_S 1165/Paris 7, Hôpital Saint Louis, Paris, France.
| | - Hui Chen
- Department of Oncology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China.
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Expression and significance of Ku80 and PDGFR-α in nasal NK/T-cell lymphoma. Pathol Res Pract 2016; 212:204-9. [DOI: 10.1016/j.prp.2015.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/01/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022]
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Dong LH, Zhang LJ, Wang WJ, Lei W, Sun X, Du JW, Gao X, Li GP, Li YF. Sequential DICE combined withl-asparaginase chemotherapy followed by involved field radiation in newly diagnosed, stage IE to IIE, nasal and extranodal NK/T-cell lymphoma. Leuk Lymphoma 2016; 57:1600-6. [DOI: 10.3109/10428194.2015.1108415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Present and Future Opportunities of the Rare Cancer Network: An International Consortium for Advancement of Oncologic Care. Rare Tumors 2015; 7:5998. [PMID: 26500735 PMCID: PMC4600997 DOI: 10.4081/rt.2015.5998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/08/2015] [Indexed: 12/28/2022] Open
Abstract
To date, the Rare Cancer Network (RCN) has initiated more than 90 studies and 54 peer-reviewed publications were produced as a result. The Second International Symposium of the Rare Cancer Network recently took place in Istanbul, Turkey on April 17-18, 2015, and update was given on multiple currently ongoing projects, while also giving room for new proposals which will shape the direction of future studies for the group. This companion issue of the RCN Proceedings summarized the findings of this meeting, while also serving as a call for fresh projects and papers which will continue to energize the group and advance the oncologic science. A brief introduction to the principles, history, and vision of the RCN was also included. To review, the academic year of 2014-15 marked an enormous success for the international members of the RCN, with the generation of 8 fully published papers and more than 12 newly proposed topics. By the collective efforts of all RCN members, in the future, we look forward to the upcoming opportunities in continuing to advance the standard of chemo- and radiotherapeutic oncologic care for selected rare tumor topics. The studies of these rare cancers often do not allow the design and execution of prospectively enrolled trials; however, these uncommon malignancies do impact the humankind and add to its suffering globally in significant ways.
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Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study. Blood 2015; 126:1424-32; quiz 1517. [PMID: 26109206 DOI: 10.1182/blood-2015-04-639336] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/15/2015] [Indexed: 12/22/2022] Open
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.
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Concurrent Etoposide, Steroid, High-dose Ara-C and Platinum chemotherapy with radiation therapy in localised extranodal natural killer (NK)/T-cell lymphoma, nasal type. Eur J Cancer 2015; 51:2386-95. [PMID: 26254810 DOI: 10.1016/j.ejca.2015.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Radiation combined with chemotherapy has recently been proposed to treat patients with localised extranodal natural killer (NK)/T lymphoma (ENKTL), nasal type. However, the modalities of the chemoradiotherapy combination and drug choices remain a matter of debate. We conducted a concurrent chemoradiotherapy (CCRT) study with the ESHAP (Etoposide, Steroid, High-dose Ara-C and Platinum) regimen. METHODS An induction phase with two upfront courses of CCRT delivering a 40Gy dose of radiation concurrently with two cycles of the ESHAP chemotherapy regimen, followed by a consolidation phase with 2-3 cycles of ESHAP chemotherapy alone. RESULTS Thirteen patients with localised ENKTL nasal type were enrolled between January 2005 and December 2014. The median age was 62years. Ten and three patients had Ann Arbor stage IE and IIE disease, respectively. They all completed the induction CCRT phase. A median of two consolidation ESHAP cycles were delivered. During consolidation, 8/13 (62%) patients had a reduction in the number of chemotherapy cycles or reduced chemotherapy doses, due to haematologically adverse events. The other five patients (38%) received the full number of ESHAP cycles of chemotherapy scheduled without a dose reduction. All but one patient (92%) experienced grade 3-4 haematological toxicity. The main non-haematological grade 3-4 toxicity was mucositis in 6/13 (46%) patients. All but one patient (92%) achieved a complete remission. Two-year overall survival was 72%. CONCLUSIONS With optimal management of the specific toxicities induced by this treatment modality, CCRT with the ESHAP regimen yielded high efficacy against localised ENKTL, nasal type.
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