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Multicenter Study
. 2022 Sep;101(9):2021-2034.
doi: 10.1007/s00277-022-04892-x. Epub 2022 Jul 8.

Comparison analysis of first-line asparaginase- versus non-asparaginase-based regimens for early-stage extranodal NK/T-cell lymphoma

Fei Qi  1 , Yan Xie  1 , Dedao Wang  1 , Yue Chai  2 , Bo Chen  3 , Yan Sun  4 , Weiping Liu  1 , Shunan Qi  3 , Yuce Wei  2 , Hui Fang  3 , Dan Zhao  4 , Lin Gui  2 , Yong Yang  3 , Xiaoli Feng  5 , Ning Ding  1 , Lan Mi  1 , Shaokun Shu  6 , Yexiong Li  3 , Yuqin Song  1 , Mei Dong #  7 , Jun Zhu #  1
Affiliations
Multicenter Study

Comparison analysis of first-line asparaginase- versus non-asparaginase-based regimens for early-stage extranodal NK/T-cell lymphoma

Fei Qi et al. Ann Hematol. 2022 Sep.

Abstract

The present study investigated the efficacy and toxicity profile of first-line asparaginase (ASP)-based versus non-ASP-based regimens in treating early-stage extranodal NK/T-cell lymphoma (ENKTCL) in non-anthracycline therapy era. This multi-center, real-world retrospective study consisted 305 newly diagnosed localized ENKTCL patients who were treated with sequential chemoradiation between 2010 and 2020 in China: 190 cases received ASP-based regimens and 115 cases received non-ASP-based regimens. Propensity score matching and multivariable analyses were used to compare survivals and toxicities between the two treatment groups. Non-ASP-based regimens achieved comparable survivals compared with ASP-based regimens in the entire cohort. The 5-year overall survival (OS), progression-free survival (PFS) rates were 84.7% and 73.5% for non-ASP-based regimens, and 87.7% (P=0.464) and 74.6% (P=0.702) for ASP-based regimens. The non-inferior survivals of non-ASP-based regimens were consistent after adjustment using PSM and multivariable analyses. However, survival benefits of ASP varied in different treatment modalities. Among patients receiving sequential chemotherapy and radiation (CT+RT±CT), ASP-based regimens achieved higher complete remission rate (54.3 vs. 34.5%, P=0.047) and more favorable survivals compared with non-ASP-based regimens (5-year OS, 87.0 vs. 69.0%, P=0.028). However, for patients receiving sequential radiation and chemotherapy (RT+CT), non-ASP-based regimens achieved comparable favorable survivals as ASP-based regimens. Besides, liver injury, malnutrition, and coagulative dysfunction were significantly more commonly documented in ASP-based regimens. These findings suggested that ASP was an effective agent in treating ENKTCL, especially among those receiving induction CT and RT. For patients who received upfront RT, non-ASP-based regimens might be a comparably effective and more tolerable treatment option.

Keywords: Asparaginase; Chemoradiation; Extranodal NK/T-cell lymphoma; Survival; Toxicity.

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