Efficacy of gemcitabine combined with oxaliplatin, L‑asparaginase and dexamethasone in patients with newly‑diagnosed extranodal NK/T‑cell lymphoma

Guo,Hong‑Qiang; Liu,Lei; Wang,Xin‑Feng; Lin,Tong‑Yu; Yao,Shu‑Na; Yao,Zhi‑Hua; Yang,Shu‑Jun

doi:10.3892/mco.2014.368

Efficacy of gemcitabine combined with oxaliplatin, L‑asparaginase and dexamethasone in patients with newly‑diagnosed extranodal NK/T‑cell lymphoma

Authors:
- Hong‑Qiang Guo
- Lei Liu
- Xin‑Feng Wang
- Tong‑Yu Lin
- Shu‑Na Yao
- Zhi‑Hua Yao
- Shu‑Jun Yang
View Affiliations

Affiliations: Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China, Department of Medical Oncology, Cancer Center, Sun Yat‑sen University, Guangzhou, Guangdong 510060, P.R. China
Published online on: August 1, 2014 https://doi.org/10.3892/mco.2014.368
Pages: 1172-1176

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

There is currently no standard first‑line regimen for patients with extranodal natural killer (NK)/T‑cell lymphoma (ENKTCL). In this study, we investigated the efficacy and toxicity of gemcitabine (GEM) combined with oxaliplatin (L‑OHP), L‑asparaginase (L‑ASP) and dexamethasone (DXM) (GOLD regimen) as a systemic treatment scheme for newly‑diagnosed ENKTCL cases. A total of 55 patients were recruited at the Henan province cancer hospital and the Cancer Center of Sun Yat‑sen University between May, 2008 and August, 2012. The GOLD regimen included a 14‑day treatment cycle with GEM (1,000 mg/m2) on day 1, L‑OHP (100 mg/m2) on day 1, L‑ASP (10,000 U/m2) on days 1‑5 and DXM (20 mg b.i.d.) on days 1‑4. The response rate, survival rate and treatment toxicity were analyzed. The overall response rate was 91% (48/55) with a complete response in 62% (34/55) and a partial response in 29% (15/55) of the patients. For all patients, the 1‑, 2‑ and 3‑year progression‑free survival (PFS) rate was 86, 64 and 57% and the overall survival (OS) 91, 80 and 74%, respectively. The 1‑year PFS in patients with stage I̸II vs. those with III/IV disease was 87 vs. 66% (p<0.001) and the 1‑year OS was 98 vs. 75%, respectively (p<0.001). No chemotherapy‑related mortality or severe complications were recorded. In conclusion, the GOLD regimen was found to be highly effective and safe for the treatment of patients with newly‑diagnosed ENKTCL.

View Figures

View References

1	Suzuki R, Takeuchi K, Ohshima K and Nakamura S: Extranodal NK/T-cell lymphoma: diagnosis and treatment cues. Hematol Oncol. 26:66–72. 2008. View Article : Google Scholar : PubMed/NCBI
2	Oshimi K: Progress in understanding and managing natural killer-cell malignancies. Br J Haematol. 139:532–544. 2007. View Article : Google Scholar : PubMed/NCBI
3	Liang Q, Ye ZY, Su ZL, et al: Clinicopathologic study of 963 cases of mature T-cell and natural killer/T-cell lymphoma with respect to 2008 WHO classification of lymphoid neoplasms. Chin J Pathol. 39:291–295. 2010.(In Chinese).
4	Li YX, Wang H, Jin J, et al: Radiotherapy alone with curative intent in patients with stage I extranodal nasal-type NK/T-cell lymphoma. Int J Radiat Oncol Biol Phys. 82:1809–1815. 2012. View Article : Google Scholar : PubMed/NCBI
5	Li YX, Yao B, Jin J, Wang WH, et al: Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol. 24:181–189. 2006. View Article : Google Scholar : PubMed/NCBI
6	Isobe K, Uno T, Tamaru J, et al: Extranodal natural killer/T-cell lymphoma, nasal type: the significance of radiotherapeutic parameters. Cancer. 106:609–615. 2006. View Article : Google Scholar : PubMed/NCBI
7	Koom WS, Chung EJ, Yang WI, et al: Angiocentric T-cell and NK/T-cell lymphomas: radiotherapeutic viewpoints. Int J Radiat Oncol Biol Phys. 59:1127–1137. 2004. View Article : Google Scholar : PubMed/NCBI
8	Wang B, Li XQ, Ma X, Hong X, Lu H and Guo Y: Immunohistochemical expression and clinical significance of P-glycoprotein in previously untreated extranodal NK/T-cell lymphoma, nasal type. Am J Hematol. 83:795–799. 2008. View Article : Google Scholar : PubMed/NCBI
9	Drénou B, Lamy T, Amiot L, et al: CD3⁻ CD56⁺ non-Hodgkin’s lymphomas with an aggressive behavior related to multidrug resistance. Blood. 89:2966–2974. 1997.
10	Jaccard A, Petit B, Girault S, et al: L-asparaginase-based treatment of 15 western patients with extranodal NK/T-cell lymphoma and leukemia and a review of the literature. Ann Oncol. 20:110–116. 2009. View Article : Google Scholar : PubMed/NCBI
11	Obama K, Tara M and Niina K: L-asparaginase-based induction therapy for advanced extranodal NK/T-cell lymphoma. Int J Hematol. 78:248–250. 2003. View Article : Google Scholar : PubMed/NCBI
12	Nagafuji K, Fujisaki T, Arima F and Ohshima K: L-asparaginase induced durable remission of relapsed nasal NK/T-cell lymphoma after autologous peripheral blood stem cell transplantation. Int J Hematol. 74:447–450. 2001. View Article : Google Scholar
13	Yong W, Zheng W, Zhu J, et al: L-asparaginase in the treatment of refractory and relapsed extranodal NK/T-cell lymphoma, nasal type. Ann Hematol. 88:647–652. 2009. View Article : Google Scholar : PubMed/NCBI
14	Ahn HK, Kim SJ, Hwang DW, Ko YH, Tang T, Lim ST and Kim WS: Gemcitabine alone and/or containing chemotherapy is efficient in refractory or relapsed NK/T-cell lymphoma. Invest New Drugs. 31:469–472. 2013. View Article : Google Scholar : PubMed/NCBI
15	Mounier N, El Gnaoui T, Tilly H, et al: Rituximab plus gemcitabine and oxaliplatin in patients with refractory/relapsed diffuse large B-cell lymphoma who are not candidates for high-dose therapy. A phase II Lymphoma Study Association trial. Haematologica. 98:1726–1731. 2013. View Article : Google Scholar : PubMed/NCBI
16	López A, Gutiérrez A, Palacios A, et al: GEMOX-R regimen is a highly effective salvage regimen in patients with refractory/relapsing diffuse large-cell lymphoma: a phase II study. Eur J Haematol. 80:127–132. 2008.PubMed/NCBI
17	El Gnaoui T, Dupuis J, Belhadj K, et al: Rituximab, gemcitabine and oxaliplatin: an effective salvage regimen for patients with relapsed or refractory B-cell lymphoma not candidates for high-dose therapy. Ann Oncol. 18:1363–1368. 2007.PubMed/NCBI
18	Nowak-Göttl U, Ahlke E, Fleischhack G, et al: Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 101:2529–2533. 2003.
19	Carbone PP, Kaplan HS, Musshoff K, Smithers DW and Tubiana M: Report of the Committee on Hodgkin’s Disease Staging Classification. Cancer Res. 31:1860–1861. 1971.
20	Cheson BD, Horning SJ, Coiffier B, et al: Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol. 17:12441999.PubMed/NCBI
21	Trotti A, Colevas AD, Setser A, et al: CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 13:176–181. 2003. View Article : Google Scholar : PubMed/NCBI
22	Au WY, Weisenburger DD, Intragumtornchai T, et al; International Peripheral T-Cell Lymphoma Project. Clinical differences between nasal and extranasal natural killer/T-cell lymphoma: a study of 136 cases from the International Peripheral T-Cell Lymphoma Project. Blood. 113:3931–3937. 2009. View Article : Google Scholar : PubMed/NCBI
23	Yong W, Zheng W and Zhang Y: Clinical characteristics and treatment of midline nasal and nasal type NK/T cell lymphoma. Zhonghua Yi Xue Za Zhi. 81:773–775. 2001.(In Chinese).
24	Lin N, Song Y, Zheng W, et al: A prospective phase II study of L-asparaginase- CHOP plus radiation in newly diagnosed extranodal NK/T-cell lymphoma, nasal type. J Hematol Oncol. 6:442013. View Article : Google Scholar : PubMed/NCBI
25	Au WY, Lie AK, Liang R, et al: Autologous stem cell transplantation for nasal NK/T-cell lymphoma: a progress report on its value. Ann Oncol. 14:1673–1676. 2003. View Article : Google Scholar : PubMed/NCBI
26	Kim HJ, Bang SM, Lee J, et al: High-dose chemotherapy with autologous stem cell transplantation in extranodal NK/T-cell lymphoma: a retrospective comparison with non-transplantation cases. Bone Marrow Transplant. 37:819–824. 2006. View Article : Google Scholar : PubMed/NCBI
27	Yamaguchi M, Kwong YL, Kim WS, et al: Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: the NK-Cell Tumor Study Group study. J Clin Oncol. 29:4410–4416. 2011. View Article : Google Scholar
28	Wu X, Li P, Zhao J, et al: A clinical study of 115 patients with extranodal natural killer/T-cell lymphoma, nasal type. Clin Oncol (R Coll Radiol). 20:619–625. 2008. View Article : Google Scholar : PubMed/NCBI
29	Li YX, Fang H, Liu QF, et al: Clinical features and treatment outcome of nasal-type NK/T-cell lymphoma of Waldeyer ring. Blood. 112:3057–3064. 2008. View Article : Google Scholar : PubMed/NCBI