Abstract
The recommended non-anthracycline (non-ANT) chemotherapy on treating Extranodal NK/T-cell lymphoma, nasal type (ENKL) is based on evidences of single-arm phase I/II studies and retrospective series with limited cases and short-term follow-ups. The current study was to investigate treatment benefit of non-ANT chemotherapy in comparison to anthracycline (ANT) chemotherapy in a large-scaled cohort. Patients consecutively diagnosed with ENKL and treated with chemotherapy with/without radiotherapy between 2000 and 2015 from 20 Chinese institutes were retrospectively analyzed. Association of short-term response and long-term survival with chemotherapy categories were evaluated. A total of 2560 cases were enrolled, 87% had stage I-II disease, and median age was 43. The proportion of non-ANT chemotherapy increased notably through 2005 to 2012. Demographic and disease characteristics showed great similarities across chemotherapy subgroups. Non-ANT chemotherapy associated with increased response comparing to ANT regimen (CR, 40 vs. 28%; PR, 43 vs.37 %, P<0.05). With a median follow-up of 4 years, overall survival (OS) and progression free survival (PFS) were significantly better favoring non-ANT chemotherapy in the entire cohort (5-year OS, 68.9% vs 57.5%, P < 0.001; 5-year PFS, 59.5% vs 44.5%, P < 0.001), localized disease (5-year OS, 73.3% vs 60.9%, P < 0.001; 5-year PFS, 64.0% vs 47.6%, P < 0.001), advanced disease (OS, 39.8% vs 29.9%, P = 0.013; PFS, 30.1% vs 18.8%, P = 0.003), and each risk subgroups, respectively. The survival benefit remained consistent after adjustments with multivariate analysis and propensity score matching analysis. Gemcitabine + L-Asparaginase combination showed promising treatment outcomes, especially for advanced disease. Non-ANT chemotherapy constituted the mainstay of chemotherapy in ENKL treatment. The application of non-ANT chemotherapy associated improved response and survival comparing to ANT chemotherapy.
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