Department of Lymphoma, Affiliated Hospital of Guizhou Medical University, Guizhou Province Tumor Hospital, Guiyang, Guizhou Province.
Department of Oncology, Third Affiliated Hospital of Army Medical University, Chongqing.
Am J Clin Oncol. 2020 Apr;43(4):257-262. doi: 10.1097/COC.0000000000000647.
Natural killer/T-cell lymphoma (NKTCL) is aggressive, and carries a poor prognosis worldwide. This retrospective study aimed to evaluate the clinical efficacy and safety of the LVD regimen (L-asparaginase, vincristine, and dexamethasone) combined with intensity-modulated radiation therapy (IMRT) for the treatment of early-stage nasal NKTCL in a Chinese population.
The clinical data were collected from patients treated between March 2010 and January 2017. Patients received LVD chemotherapy combined with IMRT, and were followed for 30 to 90 months. All received radiotherapy at the end of the first/second cycle of chemotherapy. The survival curves were generated by the Kaplan-Meier method.
Among 94 patients who received 2 to 6 cycles (mean, 4 cycles) of treatments, 56 and 25 achieved complete and partial remission, respectively; 2 and 11 experienced stable disease and progressive disease. The overall objective response was 86.2%. Patients with elevated lactate dehydrogenase and skin invasion had a lower objective response rate. The progression-free survival rates at 1, 3, and 5 years were 90.3%, 73.5%, and 71.3%; the corresponding overall survival rates were 91.4%, 74.3%, and 74.3%. The main adverse events were myelosuppression (63.8% grades I to II, 12.8% grade III), gastrointestinal symptoms (63.8% grades I to II), hepatic lesion (55.3% grades I to II), hypoproteinemia (46.8% grades I to II), skin allergies (77.7% grades I to II, 3.2% grade III), and oral mucosal lesions (44.7% grades I to II, 33% grade III). No severe pancreatitis, anaphylaxis, or toxicity-related death was observed.
In patients with early-stage nasal NKTCL, our LVD-IMRT regimen produced excellent, durable therapeutic benefit in most patients, with acceptable toxicity and no acute mortality.
自然杀伤/T 细胞淋巴瘤（NKTCL）侵袭性强，全球预后不良。本回顾性研究旨在评估 LVD 方案（门冬酰胺酶、长春新碱和地塞米松）联合调强放疗（IMRT）治疗中国人群早期鼻腔 NKTCL 的临床疗效和安全性。
收集 2010 年 3 月至 2017 年 1 月期间治疗的患者的临床资料。患者接受 LVD 化疗联合 IMRT 治疗，随访 30 至 90 个月。所有患者均在化疗第一/二周期结束时接受放疗。生存曲线采用 Kaplan-Meier 法绘制。
94 例患者接受 2 至 6 个周期（平均 4 个周期）治疗，完全缓解和部分缓解率分别为 56%和 25%；稳定疾病和进展性疾病分别为 2 例和 11 例。总客观缓解率为 86.2%。乳酸脱氢酶升高和皮肤侵犯的患者客观缓解率较低。1、3、5 年无进展生存率分别为 90.3%、73.5%和 71.3%；相应的总生存率分别为 91.4%、74.3%和 74.3%。主要不良反应为骨髓抑制（63.8%为Ⅰ至Ⅱ级，12.8%为Ⅲ级）、胃肠道症状（63.8%为Ⅰ至Ⅱ级）、肝损伤（55.3%为Ⅰ至Ⅱ级）、低蛋白血症（46.8%为Ⅰ至Ⅱ级）、皮肤过敏（77.7%为Ⅰ至Ⅱ级，3.2%为Ⅲ级）和口腔粘膜炎（44.7%为Ⅰ至Ⅱ级，33%为Ⅲ级）。未观察到严重胰腺炎、过敏反应或毒性相关死亡。
对于早期鼻腔 NKTCL 患者，我们的 LVD-IMRT 方案为大多数患者带来了极好的、持久的治疗效果，毒性可接受，无急性死亡率。
