Induction with MEDA regimen and consolidation with Auto‐HSCT for stage IV NKTCL patients: A prospective multicenter study. Issue 5 (9th June 2022)

• Record Type: Journal Article
• Authors: Liu, Chuanxu; Ding, Hao; Zhu, Qi; Liu, Peng; Zhu, Yang; Wang, Lifeng; Ma, Yujie; Zhang, Wenhao; Tian, Shu; Zhang, Xiaoyan; Jin, Lina; Liu, Ligen; Li, Zhichao; Hao, Siguo; Tao, Rong
• Is Part Of: International journal of cancer. Volume 151:Issue 5(2022)
• Page Start: 752
• Page End: 763
• Publication Date: 2022-06-09
• Subjects: autologous hematopoietic stem cell transplantation -- L‐asparaginase‐based chemotherapy -- natural killer/T‐cell lymphoma; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34055
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Optimal treatment strategies for natural killer/T‐cell lymphoma (NKTCL) patients with stage IV disease have not been well defined. In this prospective phase 2 study, we evaluated the treatment using MEDA (methotrexate, etoposide, dexamethasone and pegaspargase) as induction chemotherapy and autologous hematopoietic stem cell transplantation (Auto‐HSCT) for consolidation. Patients with stage IV disease without prior L‐asparaginase‐based chemotherapy were eligible. Four cycles of MEDA were administered as induction treatment. Patients with complete response (CR, necessary to have complete metabolic remission of PET/CT, negative plasma EBV‐DNA and negative EBER staining of bone marrow biopsy tissue) were consolidated by Auto‐HSCT. A total of 53 patients were enrolled. The overall response (OR) rate and CR rate after four cycles of MEDA chemotherapy were 75.5% and 56.6%, respectively. Among them, 25 patients underwent Auto‐HSCT. The 4‐year overall survival (OS) rate and progression‐free survival (PFS) rate were 58.0% (95% CI, 43.4%‐70.0%) and 43.4% (95% CI, 29.9%‐56.1%), respectively. Patients who underwent Auto‐HSCT had a 4‐year OS rate of 92.0% (95% CI, 71.6%‐97.9%) and a 4‐year PFS rate of 80.0% (95% CI, 58.4%‐91.1%). Grade 3/4 neutropenia and thrombocytopenia occurred in 28.3% and 17.0% of the patients, respectively. MEDA chemotherapy is an effective induction regimen with reduced grade 3/4 hematological toxicities for stage IV NKTCL. Consolidation with Auto‐HSCT can be considered as a potential approach to improve the long‐term survival of CR patients after induction treatment. Abstract : What's new? Although advanced‐stage natural killer/T‐cell lymphoma (NKTCL) is typically treated with L‐asparaginase‐based multiagents, disease progression and relapse after chemotherapy is common. A minority of patients also receive autologous or allogeneic hematopoietic stem cell transplantation as a consolidative treatment. However, the optimal chemotherapy regimen and treatment strategy remain largely unknown. This prospective phase 2 study provides the rationale for the use of MEDA (methotrexate, etoposide, dexamethasone and pegaspargase) as induction chemotherapy and autologous hematopoietic stem cell transplantation consolidative therapy as a first‐line treatment in advanced‐stage NKTCL. For patients who fail L‐asparaginase‐based therapy, anti‐PD‐1 antibody may be an effective treatment.