Abstract
GELOX (gemcitabine, oxaliplatin and L-asparaginase) regimen showed an impressive result in our previous study, but the effect of this new regimen is still dissatisfying for some patients, so it is necessary to identify which patients will benefit from this regimen. A total of fifty-one cases with nasal natural killer/T-cell lymphoma receiving initial GELOX chemotherapy were enrolled in this study. The ki-67 expression detected by immunohistochemistry (IHC) in the specimens ranged from 10% to 90%, with a median value of 70%, so cases higher than the median value (≥70%) were defined as high ki-67 expression, and the others were designated as low ki-67 expression. The response rate had no statistical difference between low ki-67 expression group and high ki-67 expression group (P=0.291) though the value in the former group was relatively high. After a median follow-up of 18.03 months, the 3-year progression-free survival (PFS) for patients with low ki-67 expression was significantly higher than those with high ki-67 expression (83.8% vs. 47.9%, P=0.038). In the stage I/II subgroup, 3-year PFS and overall survival (OS) were statistically higher in the patients with low ki-67 expression than those with high ki- 67 expression. Multivariate analysis revealed high ki-67 expression was an independent prognostic factor for PFS. These results suggest that low ki-67 expression can predict a good response of GELOX in these patients, and the combination of ki-67 expression and early stage is helpful to identify an excellent prognosis subgroup from patients receiving GELOX in this disease.
Highlights
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a relatively common disease in China (Liu et al, 2011)
Based on the low toxicity and good effect of gemcitabine and oxaliplatin in B-cell and T-cell lymphoma (Oki et al, 2005; El Gnaoui et al, 2007; Zinzani et al, 2010), we evaluated the effect of GELOX in the firstline chemotherapy of stage I/II ENKTL in a prospective study (Wang et al, 2013)
*Abbreviations: ENKTL, extranodal natural killer /T-cell lymphoma; LDH, lactate dehydrogenase; International Prognostic Index (IPI), international prognostic index; Korean Prognostic Index (KPI), Korean prognostic index; PFS, progression-free survival; OS, overall survival the independent prognostic factors for PFS were high ki-67 expression (P=0.026; relative risk, 6.777; 95% CI 1.234-37.208) and KPI (P=0.014; relative risk, 4.463; 95% CI 1.355-14.698)
Summary
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a relatively common disease in China (Liu et al, 2011). Based on the low toxicity and good effect of gemcitabine and oxaliplatin in B-cell and T-cell lymphoma (Oki et al, 2005; El Gnaoui et al, 2007; Zinzani et al, 2010), we evaluated the effect of GELOX in the firstline chemotherapy of stage I/II ENKTL in a prospective study (Wang et al, 2013). This new regimen produced an impressive result that the complete response (CR) rate was as high as 55.6% after 2-cycle chemotherapy. It is necessary to identify which patients will benefit from the GELOX regimen
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