比较分析早期结外 NK/T 细胞淋巴瘤一线 asparaginase 方案与非 asparaginase 方案。
Comparison analysis of first-line asparaginase- versus non-asparaginase-based regimens for early-stage extranodal NK/T-cell lymphoma.
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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.
出版信息
Ann Hematol. 2022 Sep;101(9):2021-2034. doi: 10.1007/s00277-022-04892-x. Epub 2022 Jul 8.
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.
本研究旨在探讨在非蒽环类药物治疗时代，一线门冬酰胺酶（ASP）为基础与非 ASP 为基础方案治疗早期结外 NK/T 细胞淋巴瘤（ENKTCL）的疗效和毒性特征。这项多中心、真实世界的回顾性研究纳入了 305 例 2010 年至 2020 年在中国接受序贯放化疗的新诊断局限性 ENKTCL 患者：190 例接受 ASP 为基础的方案，115 例接受非 ASP 为基础的方案。采用倾向评分匹配和多变量分析比较两组的生存和毒性。非 ASP 为基础的方案在整个队列中的生存与 ASP 为基础的方案相当。非 ASP 为基础的方案的 5 年总生存率（OS）和无进展生存率（PFS）分别为 84.7%和 73.5%，ASP 为基础的方案分别为 87.7%（P=0.464）和 74.6%（P=0.702）。多变量分析和倾向评分匹配后，非 ASP 为基础方案的非劣效生存结果一致。然而，ASP 的生存获益在不同的治疗方式中有所不同。在接受序贯化疗和放疗（CT+RT±CT）的患者中，与非 ASP 为基础的方案相比，ASP 为基础的方案获得更高的完全缓解率（54.3% vs. 34.5%，P=0.047）和更有利的生存（5 年 OS，87.0% vs. 69.0%，P=0.028）。然而，对于接受序贯放疗和化疗（RT+CT）的患者，非 ASP 为基础的方案与 ASP 为基础的方案具有相当的生存获益。此外，肝损伤、营养不良和凝血功能障碍在 ASP 为基础的方案中更为常见。这些发现表明，ASP 是治疗 ENKTCL 的有效药物，尤其是在接受诱导 CT 和 RT 的患者中。对于接受初始 RT 的患者，非 ASP 为基础的方案可能是一种同样有效且更耐受的治疗选择。
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