Treatment outcome and prognosis of patients with stage I-II nasal-type natural killer/T-cell lymphoma receiving induction chemotherapy with GELOX regimen and radical radiotherapy

Abstract

Objective To investigate the treatment outcome and prognostic factors in patients with early-stage extranodal nasal-type natural killer/T-cell lymphoma (ENKTL) who underwent chemotherapy with GELOX (gemcitabine, oxaliplatin, and L-asparaginase) regimen combined with radiotherapy. Methods The clinical data of 74 patients with stage IE-IIE ENKTL who were admitted from 2007 to 2013 were analyzed retrospectively, and based on the chemoradiotherapy regimen and whether they underwent radiotherapy, these patients were divided into three groups. The 47 patients in group A received the preferred chemotherapy with GELOX regimen and then radical radiotherapy; the 10 patients in group B received another regimen at first, then received GELOX as the rescue chemotherapy, and underwent radiotherapy; the 17 patients in group C underwent the chemotherapy with GELOX regimen and did not receive radiotherapy. The median number of cycles of chemotherapy was 3, and the median dose of radiotherapy was 54.6 Gy in 20-30 fractions. Results The complete response (CR) rate after chemotherapy was 34% and the CR rate after radiotherapy was 90%.The 2-year overall survival (OS) and progression-free survival (PFS) rates were 88% and 79%, respectively. The CR rate and 2-year OS and PFS rates for group A+ C were 73%, 92%, and 84%, respectively. Group A had significantly higher OS and PFS than group B and group C (96%/84% vs. 50%/45% and 47%/40%; all P<0.05). The univariate analysis showed that elevated lactate dehydrogenase level and no response after chemotherapy were the adverse prognostic factors for OS and PFS, and extensive local invasion was the adverse prognostic factor for OS.The multivariate prognostic analysis indicated that no response after chemotherapy was the adverse prognostic factor for OS and PFS. Conclusions The patients with early-stage ENKTL can achieve a good outcome after induction chemotherapy with GELOX regimen combined with radical radiotherapy, but this regimen has no ideal efficacy when applied alone or as rescue chemotherapy. Key words: NK/T cell lymphoma/radiotherapy; NK/T cell lymphoma/ chemotherapy; Prognosis