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.,American Journal of Hematology

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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.
American Journal of Hematology ( IF 12.8 ) Pub Date : 2020-05-25 , DOI: 10.1002/ajh.25878
Shu-Nan Qi ₁ , Yong Yang ₁ , Yu-Jing Zhang ₂ , Hui-Qiang Huang ₃ , Ying Wang ₄ , Xia He ₅ , Li-Ling Zhang ₆ , Gang Wu ₆ , Bao-Lin Qu ₇ , Li-Ting Qian ₈ , Xiao-Rong Hou ₉ , Fu-Quan Zhang ₉ , Xue-Ying Qiao ₁₀ , Hua Wang ₁₁ , Gao-Feng Li ₁₂ , Yuan Zhu ₁₃ , Jian-Zhong Cao ₁₄ , Jun-Xin Wu ₁₅ , Tao Wu ₁₆ , Su-Yu Zhu ₁₇ , Mei Shi ₁₈ , Li-Ming Xu ₁₉ , Zhi-Yong Yuan ₁₉ , Hang Su ₂₀ , Yu-Qin Song ₂₁ , Jun Zhu ₂₁ , Chen Hu ₂₂ , Ye-Xiong Li ₁

Affiliation

Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
Department of Medical Oncology, Sun Yat-sen University Cancer Center, China.
Department of Radiation Oncology, Chongqing University Cancer Hospital & Chongqing Cancer Hospital, Chongqing, China.
Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiation Oncology, The General Hospital of Chinese People's Liberation Army, Beijing, China.
Department of Radiation Oncology, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China.
Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China.
Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Radiation Oncology, Second Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Radiation Oncology, Beijing Hospital, National Geriatric Medical Center, Beijing, China.
Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China.
Department of Radiation Oncology, Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, China.
Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China.
Department of Radiation Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, China.
Department of Radiation Oncology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, China.
Department of Radiation Oncology, Xijing Hospital of Fourth Military Medical University, Xi'an, China.
Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin, China.
Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China.
Department of Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

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.

更新日期：2020-05-25

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