Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, China.
Clin Transl Sci. 2021 Jan;14(1):405-411. doi: 10.1111/cts.12893. Epub 2020 Oct 12.
Extranodal natural killer/T-cell lymphoma, nasal type (ENKL) is a rare peripheral T-cell lymphoma that predominantly occurs in Asian and South American populations. The treatment of ENKL has been a challenge for a long time. This study was conducted to compare the clinical efficacy and safety of cisplatin, dexamethasone, gemcitabine, and pegaspargase (DDGP) and methotrexate, dexamethasone, ifosfamide, L-asparaginase, and etoposide (SMILE) regimens for relapsed/refractory ENKL and explore the prognostic factors. From October 2014 to July 2019, 54 patients with relapsed/refractory ENKL who received DDGP or SMILE chemotherapy were retrospectively assessed in this study. Thirty-one patients received DDGP chemotherapy and 23 patients received SMILE chemotherapy. A higher complete response rate was observed in patients treated with DDGP regimen (61.3% vs. 30.4%, P = 0.025). The DDGP group (95% confidence interval (CI) of 5-year progression-free survival (PFS): 24.6-66.2%; 95% CI of 5-year overall survival (OS): 8.5-91.7%) was also significantly associated with longer 5-year PFS and 5-year OS (P = 0.008 for 5-year PFS, P = 0.023 for 5-year OS). More serious leucopenia (P = 0.021), neutropenia (P = 0.041), and allergy (P = 0.040) were observed in the SMILE group. Post-treatment Epstein-Barr virus (EBV)-DNA status (P = 0.001 for PFS, P = 0.018 for OS) was identified as a significant prognostic factor for PFS and OS in multivariate analysis. The present research suggested that compared with SMILE chemotherapy, DDGP chemotherapy can significantly improve the response and survival of relapsed/refractory ENKL with better tolerance. Post-treatment EBV-DNA status was identified as a significant prognostic factor for PFS and OS in relapsed/refractory ENKL.
结外 NK/T 细胞淋巴瘤，鼻型（ENKL）是一种罕见的外周 T 细胞淋巴瘤，主要发生在亚洲和南美洲人群中。ENKL 的治疗一直是一个挑战。本研究旨在比较顺铂、地塞米松、吉西他滨和培门冬酶（DDGP）与甲氨蝶呤、地塞米松、异环磷酰胺、左旋门冬酰胺酶和依托泊苷（SMILE）方案治疗复发/难治性 ENKL 的临床疗效和安全性，并探讨预后因素。本研究回顾性分析了 2014 年 10 月至 2019 年 7 月接受 DDGP 或 SMILE 化疗的 54 例复发/难治性 ENKL 患者。31 例患者接受 DDGP 化疗，23 例患者接受 SMILE 化疗。DDGP 组完全缓解率较高（61.3% vs. 30.4%，P=0.025）。DDGP 组（5 年无进展生存（PFS）的 95%置信区间（CI）：24.6-66.2%；5 年总生存（OS）的 95%CI：8.5-91.7%）与更长的 5 年 PFS 和 5 年 OS 显著相关（P=0.008 用于 5 年 PFS，P=0.023 用于 5 年 OS）。SMILE 组观察到更严重的白细胞减少（P=0.021）、中性粒细胞减少（P=0.041）和过敏（P=0.040）。多因素分析显示，治疗后 EBV-DNA 状态（PFS 的 P=0.001，OS 的 P=0.018）是影响 PFS 和 OS 的显著预后因素。本研究表明，与 SMILE 化疗相比，DDGP 化疗可显著提高复发/难治性 ENKL 的缓解率和生存率，且耐受性更好。治疗后 EBV-DNA 状态是复发/难治性 ENKL 患者 PFS 和 OS 的显著预后因素。
