Association of improved overall survival with decreased distant metastasis following asparaginase-based chemotherapy and radiotherapy for intermediate- and high-risk early-stage extranodal nasal-type NK/T-cell lymphoma: a CLCG study

• Published in: ESMO open Vol. 6; no. 4; p. 100206
• Main Authors: Zheng, X., He, X., Yang, Y., Liu, X., Zhang, L.L., Qu, B.L., Zhong, Q.Z., Qian, L.T., Hou, X.R., Qiao, X.Y., Wang, H., Zhu, Y., Cao, J.Z., Wu, J.X., Wu, T., Zhu, S.Y., Shi, M., Xu, L.M., Zhang, H.L., Su, H., Song, Y.Q., Zhu, J., Zhang, Y.J., Huang, H.Q., Wang, Y., Chen, F., Yin, L., Qi, S.N., Li, Y.X.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.08.2021; Elsevier
• Subjects: asparaginase; chemotherapy; NK/T-cell lymphoma; Original Research; radiotherapy; survival outcome; radiotherapy; survival outcome; NK/T-cell lymphoma; asparaginase; chemotherapy
• ISSN: 2059-7029; 2059-7029
• DOI: 10.1016/j.esmoop.2021.100206

This study evaluated the survival benefit of asparaginase (ASP)-based versus non-ASP-based chemotherapy combined with radiotherapy in a real-world cohort of patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTCL). We identified 376 patients who received combined radiotherapy with either ASP-based (ASP, platinum, and gemcitabine; n = 286) or non-ASP-based (platinum and gemcitabine; n = 90) regimens. The patients were stratified into low-, intermediate-, and high-risk groups using the early stage-adjusted nomogram-revised risk index. Overall survival (OS) and distant metastasis (DM)-free survival (DMFS) between the chemotherapy regimens were compared using inverse probability of treatment weighting (IPTW) and multivariable analyses. ASP-based (versus non-ASP-based) regimens significantly improved 5-year OS (84.5% versus 73.2%, P = 0.021) and DMFS (84.4% versus 74.5%, P = 0.014) for intermediate- and high-risk patients, but not for low-risk patients in the setting of radiotherapy. Moreover, ASP-based regimens decreased DM, with a 5-year cumulative DM rate of 14.9% for ASP-based regimens compared with 25.1% (P = 0.014) for non-ASP-based regimens. The survival benefit of ASP-based chemotherapy and radiotherapy remained consistent after adjusting the confounding variables using IPTW and multivariate analyses; additional sensitivity analyses confirmed these results. The findings provided support for ASP-based chemotherapy and radiotherapy as a first-line treatment strategy for intermediate- and high-risk early-stage ENKTCL. •We explored the benefit of ASP-based chemotherapy in first-line combined-modality therapy of early-stage ENKTCL in a large real-world data set.•Current-era and most commonly used regimens were selected and compared.•Adding ASP into platinum and gemcitabine-based chemotherapy improved OS and DMFS in intermediate- and high-risk patients.•This is the first study to demonstrate clear associations of decreased DM and improved OS in early-stage ENKTCL patients.