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, ,

  • 1 Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing 100142, China
  • 2 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
  • 3 Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing 100142, China
  • 4 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
  • 5 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
* Equal contribution and co-first authors

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

https://doi.org/10.18632/aging.204355
How to Cite

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.

Abbreviations

ANT: anthracycline; COEPL: cyclophosphamide, vincristine, etoposide, prednisone, and L-asparaginase/pegaspargase; CHOPL/CHOPEL: cyclophosphamide, doxorubicin, vincristine, prednisone, L-asparaginase/pegaspargase with or without etoposide; CR: complete remission; CRT: chemoradiotherapy; CT: chemotherapy; ECOG: Eastern Cooperative Oncology Group performance status; EPOCHL: (etoposide, vincristine, doxorubicin, prednisone, cyclophosphamide, L-asparaginase/pegaspargase); GDP: gemcitabine, cisplatin and dexamethasone; GDPL: gemcitabine, cisplatin, dexamethasone, and L-asparaginase/pegaspargase; GELOX: gemcitabine, oxaliplatin and L-asparaginase/pegaspargase; HR: hazard ratio; 95% CI: 95% confidence interval; IPI: International Prognostic Index; IMRT: intensity modulated radiation therapy; LDH: lactate dehydrogenase; LRC: locoregional control; LRF: locoregional failure; NKTCL: natural killer/T cell lymphoma; NRI: nomogram-revised risk index; ORR: overall response rate; OS: overall survival; PET: positron emission tomography; PD: progression of disease; PFS: progression-free survival; PINK: Prognostic index of natural killer lymphoma; PTI: primary tumor invasion; PR: partial remission; RT: radiotherapy; SD: stable disease; SF: systemic failure; UADT: upper aerodigestive tract; VMAT: volumetric modulated Arc therapy.