PEG-L-CHOP treatment is safe and effective in adult extranodal NK/T-cell lymphoma with a low rate of clinical hypersensitivity

• Published in: BMC cancer 2018-09, Vol.18 (1), p.910-9, Article 910
• Main Authors: Zheng, Wen, Gao, Yuhuan, Ke, Xiaoyan, Zhang, Weijing, Su, Liping, Ren, Hanyun, Lin, Ningjing, Xie, Yan, Tu, Meifeng, Liu, Weiping, Ping, Lingyan, Ying, Zhitao, Zhang, Chen, Deng, Lijuan, Wang, Xiaopei, Song, Yuqin, Zhu, Jun
• Format: Article
• Language: English
• Subjects: Acute lymphoblastic leukemia; Adult; Aged; Allergic reaction; Allergy; Analysis; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Asparaginase; Asparaginase - administration & dosage; Biomarkers; Bone marrow; Cancer; Cancer therapies; Care and treatment; Chemotherapy; Children; Chinese; Clinical trial; Clinical trials; Cyclophosphamide; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Cytotoxicity; Doxorubicin; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Drug dosages; Drug Resistance, Neoplasm; E coli; Extranodal natural killer (NK)/T-cell lymphoma (NKTCL); FDA approval; Female; Fibrinogen; Follow-Up Studies; Gastrointestinal tract; Health aspects; Humans; Hypersensitivity; Immunogenicity; Immunotherapy; L-asparaginase; Leukemia; Liver diseases; Lymphatic leukemia; Lymphocytes; Lymphocytes T; Lymphoma; Lymphoma, Extranodal NK-T-Cell - diagnosis; Lymphoma, Extranodal NK-T-Cell - drug therapy; Lymphoma, Extranodal NK-T-Cell - radiotherapy; Male; Medical prognosis; Middle Aged; Myelosuppression; Natural killer cells; Neoplasm Metastasis; Neoplasm Staging; Patients; Pediatrics; PEG-ASP; Polyethylene glycol; Polyethylene glycol-conjugated asparaginase (pegaspargase; Polyethylene Glycols - administration & dosage; Prednisolone; Prednisone - adverse effects; Prednisone - therapeutic use; Radiation therapy; Safety and security measures; Studies; T cell lymphoma; Therapy; Treatment Outcome; Vincristine - adverse effects; Vincristine - therapeutic use; Viruses
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-018-4782-y

The combination of chemotherapy and L-asparaginase (L-ASP) treatment significantly increased survival rate in an adult patient with extranodal natural killer (NK)/T-cell lymphoma (NKTCL). However, hypersensitivity reactions of L-ASP in some patients limited its application. Polyethylene glycol-conjugated asparaginase (PEG-ASP) has a lower immunogenicity and longer circulating half-life than unconjugated L-ASP, and has been reported to be effective and well-tolerated in children with acute lymphoblastic leukemia. Cyclophosphamide, hydroxydaunorubicin (doxorubicin), oncovin (vincristine), and prednisolone (CHOP) is the most common chemotherapy for non-Hodgkin lymphoma. In this report, we sought to study the efficacy and safety of PEG-L- CHOP in NKTCL in adult Chinese patients. Our study is a prospective, multi-center, open-label clinical trial. Patients with newly diagnosed adult NKTCL and an ECOG performance status of 0 to 2 were eligible for enrollment. Treatment included six cycles of PEG-L-CHOP regimen. Radiotherapy was scheduled after 2-4 cycles of PEG-L-CHOP regimen, depending on the stage and primary anatomic site. We enrolled a total of 33 eligible patients. All 33 patients completed 170 cycles of chemotherapy combined with radical radiotherapy. The overall response rate was 96.9% (32/33) with 75.8% (25/33) achieving complete responses and 21.2% (7/33) achieving partial responses. The overall survival (OS) at 1, 2, 3-year were 100, 90.61 and 80.54%, respectively. The major adverse effects were bone marrow suppression, reduction of fibrinogen level, liver dysfunction, and digestive tract toxicities. No allergic reaction and no treatment-related mortality or severe complications were recorded. PEG-L-CHOP chemotherapy in combination radiotherapy is safe and durably effective treatment for adult extranodal NK/T-cell lymphoma with fewer allergic reactions. This study was approved by the Peking University Beijing Cancer Hospital Ethics Review Committee (reference number: 2011101104). The clinical trial registration number ChiCTR1800016940 was registered on July 07, 2018 at the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ). The clinical trial was registered retrospectively.