Risk‐based, response‐adapted therapy for early‐stage extranodal nasal‐type NK/T‐cell lymphoma in the modern chemotherapy era: A China Lymphoma Collaborative Group study

• Published in: American journal of hematology Vol. 95; no. 9; pp. 1047 - 1056
• Main Authors: Qi, Shu‐Nan, Yang, Yong, Zhang, Yu‐Jing, Huang, Hui‐Qiang, Wang, Ying, He, Xia, Zhang, Li‐Ling, Wu, Gang, Qu, Bao‐Lin, Qian, Li‐Ting, Hou, Xiao‐Rong, Zhang, Fu‐Quan, Qiao, Xue‐Ying, Wang, Hua, Li, Gao‐Feng, Zhu, Yuan, Cao, Jian‐Zhong, Wu, Jun‐Xin, Wu, Tao, Zhu, Su‐Yu, Shi, Mei, Xu, Li‐Ming, Yuan, Zhi‐Yong, Su, Hang, Song, Yu‐Qin, Zhu, Jun, Hu, Chen, Li, Ye‐Xiong
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2020; Wiley Subscription Services, Inc; Wiley Blackwell (John Wiley & Sons)
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Chemoradiotherapy; Chemotherapy; Child; Child, Preschool; China; Disease-Free Survival; Female; Follow-Up Studies; Hematology; Humans; Lymphoma; Lymphoma, Extranodal NK-T-Cell - mortality; Lymphoma, Extranodal NK-T-Cell - therapy; Male; Middle Aged; Nomograms; Radiation therapy; Risk Assessment; Risk groups; Survival Rate; T-cell lymphoma; China
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.25878

We aimed to determine the survival benefits of chemotherapy (CT) added to radiotherapy (RT) in different risk groups of patients with early‐stage extranodal nasal‐type NK/T‐cell lymphoma (ENKTCL), and to investigate the risk of postponing RT based on induction CT responses. A total of 1360 patients who received RT with or without new‐regimen CT from 20 institutions were retrospectively reviewed. The patients had received RT alone, RT followed by CT (RT + CT), or CT followed by RT (CT + RT). The patients were stratified into different risk groups using the nomogram‐revised risk index (NRI). A comparative study was performed using propensity score‐matched (PSM) analysis. Adding new‐regimen CT to RT (vs RT alone) significantly improved overall survival (OS, 73.2% vs 60.9%, P < .001) and progression‐free survival (PFS, 63.5% vs 54.2%, P < .001) for intermediate‐risk/high‐risk patients, but not for low‐risk patients. For intermediate‐risk/high‐risk patients, RT + CT and CT + RT resulted in non‐significantly different OS (77.7% vs 72.4%; P = .290) and PFS (67.1% vs 63.1%; P = .592). For patients with complete response (CR) after induction CT, initiation of RT within or beyond three cycles of CT resulted in similar OS (78.2% vs 81.7%, P = .915) and PFS (68.2% vs 69.9%, P = .519). For patients without CR, early RT resulted in better PFS (63.4% vs 47.6%, P = .019) than late RT. Risk‐based, response‐adapted therapy involving early RT combined with CT is a viable, effective strategy for intermediate‐risk/high‐risk early‐stage patients with ENKTCL in the modern treatment era.