Ifosfamide, methotrexate, etoposide, and prednisolone plus L=asparaginase as a first-time therapy in stage III/IV NK/T-cell lumphoma, nasal typr

Abstract

Introduction: The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although L-asparaginase (L-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of L-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Patients and Methods: Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus L-asp (N=22) or combination chemotherapy without L-asp (N=48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. Results: After a median follow-up period of 12.8 months (range, 1.1-186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 months and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus L-asp compared to those treated with chemotherapy without L-asp (overall response rate 90.0% vs. 34.8%, P < 0.001

complete remission rate 65.0% vs. 21.7%, P = 0.001). The OS and PFS were significantly higher for the IMEP plus L-asp group compared with the chemotherapy without L-asp group. In a multivariate analysis, use of chemotherapy without L-asp was an independent predictor for reduced OS (hazards ratio (HR) = 2.18, 95% confidence interval (CI) 1.08-4.40

P = 0.030) and PFS (HR = 2.29, 95% CI 1.22-4.29

P = 0.010). Conclusions: IMEP plus L-asp is active against stage III/IV NTCL, and it is an independent predictor for improved survival.