Efficacy and Safety of Gemcitabine-Based Combination Regimens in Patients with Extranodal Natural Killer/T Cell Lymphoma, Nasal Type

• Published in: Blood 2014-12, Vol.124 (21), p.3071-3071
• Main Authors: Wang, Jingjing, Dong, Mei, He, Xiaohui, Wang, Weihu, Liu, Peng, Yang, Jianliang, Qin, Yan, Gui, Lin, Yang, Sheng, Li, Yexiong, Shi, Yuankai, Qiu, Lugui
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V124.21.3071.3071

Purpose Extranodal natural killer/T-cell lymphoma, nasal type (ENKTL), is a highly aggressive non-Hodgkin lymphoma (NHL) with poor prognosis. For localized upper aerodigestive tract (UADT) cases, radiotherapy alone or chemotherapy plus radiotherapy yields relatively favorable prognosis. In contrast, historically, cases with advanced-stage disease or involving the extra-upper aerodigestive tract (extra-UADT) are primarily treated with anthracycline-containing chemotherapy and result in poor long-term survival due to high expression of p-glycoprotein In addition, for localized UADT disease, the overall treatment failure rate is 30%-40%, with most of the relapses being distant metastases[1-2]. Therefore, effective chemotherapeutic regimens are needed for the cases metastatic UADT and extra-UADT disease. Some studies have reported the efficacy of L-asparaginase in patients with ENKTL. The use of the SMILE (steroid, methotrexate, ifosfamide, L-asparaginase, and etoposide) regimen was limited by a high rate of hypersensitivity reactions and severe myelosuppression[3-5]. Our previous study has demonstrated the high activity and low toxicity of gemcitabine-based regimens in patients with peripheral T cell lymphoma [6]. In this study, we aim to assess the efficacy and safety of gemcitabine-based regimens in ENKTL patients. Patients and methods We retrospectively reviewed 54 patients with ENKTL who received gemcitabine-based regimens between January 2008 and December 2013. 34 newly-diagnosed patients and 20 refractory/relapsed patients were enrolled. There were 27 cases of early-stage and 27 cases of advanced-stage disease. GDP (gemcitabine intravenously 1250mg/m2 on days 1 and 8; cisplatin 25mg/m2 intravenously on days 1-3; and dexamethasone 20mg/d orally on days 1-4 and days 11-14) was given to 35 patients, and P-GDP (pegaspargase 2500U/m2 intramuscularly on day 8, gemcitabine, dexamethasone, and cisplatin) given to 19 patients. The regimens were administered in 21--day cycles. Radical involved-field radiotherapy or palliative radiotherapy was implemented as necessary. Results A total of 237 cycles of treatment were administered and the median number of cycles per patient was 4 (range 2-8). 24 of the 27 early-stage patients and 4 of the 27 advanced-stage patients received radiotherapy. 2 patients received hematologic stem cell transplantation as consolidation treatment. The complete-remission rate, partial-remission rate, stable-disease rate and progressive-diseas