Research Paper|Volume 14, Issue 21|pp 8729—8744

Deep remission from induction chemotherapy predicts favorable long-term survivals in early stage extranodal nasal NK/T-cell lymphoma receiving sequential chemotherapy and radiation

Fei Qi¹, Wenyuan Zhou², Yan Xie¹, Yan Sun³, Meng Wu¹, Yue Chai⁴, Bo Chen⁵, Ningjing Lin¹, Weiping Liu¹, Ning Ding¹, Yexiong Li⁵, Mei Dong⁴, Yuqin Song¹, Jun Zhu¹

¹Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
²NMPA 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
³Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
⁴Department 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
⁵Department 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

* Equal contribution and co-first authors

Received: June 16, 2022Accepted: August 25, 2022Published: November 1, 2022

https://doi.org/10.18632/aging.204355

Copyright: © 2022 Qi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: We aimed to assess the association between induction chemotherapy (CT) response and survivals and to explore an induction CT response-adapted treatment strategy for localized extranodal NK/T-cell lymphoma (NKTCL) receiving first-line sequential CT and radiation (RT).

Methods: We retrospectively reviewed the data of patients with localized NKTCL receiving first-line CT+RT from 2010 to 2020 at two independent institutes (primary cohort, n = 203; validation cohort, n = 67). Responses after induction CT (initial response), RT (final response) and survivals were analyzed.

Results: Patients with initial complete remission (CR) had higher final CR rate than the others (99.1% vs. 78.7%, P < 0.001). Initial CR was associated with superior 5-year progression-free survival (PFS, 90.0% vs. 61.4% vs. 30.8%, P < 0.001) and overall survival (OS, 93.5% vs. 70.7% vs. 60.6%, P < 0.001), as compared to initial partial remission or non-response. Though majority of cases with initial non-CR achieved final CR after RT, they still had a tendency of shortened OS compared with initial CRs (86.9% vs. 90.6%, P = 0.063). Multivariate analysis demonstrated patients with initial non-CR had higher relapse (HR = 4.748, 95% CI, 2.396–9.407, P < 0.001) and death hazard (HR = 4.296, 95% CI, 1.802–10.24, P = 0.001). Furthermore, more intensive therapy of ≥6 total cycles of CT yielded significantly superior 5-year OS for patients with initial non-CR (76.7% vs. 54.7%, P = 0.026) rather than patients with initial CR.

Conclusion: Deep remission from induction CT was associated with favorable survivals in localized NKTCL receiving CT+RT, and an induction CT response-adapted individualized treatment strategy might be recommended in clinical practice.