Hematological oncology · 2022
Long-term outcomes and central nervous system relapse in extranodal natural killer/T-cell lymphoma.
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Miyazaki Kana, Suzuki Ritsuro, Oguchi Masahiko, Taguchi Senzo, Amaki Jun, Maeda Takeshi, Kubota Nobuko, Maruyama Dai, Terui Yasuhito, Sekiguchi Nodoka, Takizawa Jun, Tsukamoto Hiroyuki, Murayama Tohru, Ando Toshihiko, Matsuoka Hiroshi, Hasegawa Masatoshi, Wada Hideho, Sakai Rika, Kameoka Yoshihiro, Tsukamoto Norifumi, Choi Ilseung, Masaki Yasufumi, Shimada Kazuyuki, Fukuhara Noriko, Utsumi Takahiko, Uoshima Nobuhiko, Kagami Yoshitoyo, Asano Naoko, Ejima Yasuo, Katayama Naoyuki, Yamaguchi Motoko
Аннотация
To elucidate the long-term outcomes of non-anthracycline-containing therapies and central nervous system (CNS) events in patients with extranodal NK/T-cell lymphoma, nasal type (ENKTL), the clinical data of 313 patients with ENKTL diagnosed between 2000 and 2013 in a nationwide retrospective study in Japan were updated and analyzed. At a median follow-up of 8.4 years, the 5-year overall survival (OS) and progression-free survival (PFS) were 71% and 64%, respectively, in 140 localized ENKTL patients who received radiotherapy-dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC) in clinical practice. Nine (6.4%) patients experienced second malignancies. In 155 localized ENKTL patients treated with RT-DeVIC, 10 (6.5%) experienced CNS relapse (median, 12.8 months after diagnosis). In five of them, the events were confined to the CNS. Nine of the 10 patients who experienced CNS relapse died within 1 year after CNS relapse. Multivariate analysis identified gingival (hazard ratio [HR], 54.35; 95% confidence interval [CI], 8.60-343.35) and paranasal involvement (HR, 7.42; 95% CI, 1.78-30.89) as independent risk factors for CNS relapse. In 80 advanced ENKTL patients, 18 received steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) chemotherapy as first-line treatment. Patients who received SMILE as their first-line treatment tended to have better OS than those who did not (p = 0.071). Six (7.5%) advanced ENKTL patients experienced isolated CNS relapse (median, 2.6 months after diagnosis) and died within 4 months of relapse. No second malignancies were documented in advanced ENKTL patients. In the entire cohort, the median OS after first relapse or progression was 4.6 months. 12 patients who survived 5 years after PFS events were disease-free at the last follow-up. Of those, 11 (92%) underwent hematopoietic stem cell transplantation. Our 8-year follow-up revealed the long-term efficacy and safety of RT-DeVIC and SMILE. The risk of CNS relapse is an important consideration in advanced ENKTL.