title: Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus L-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL).
abstract: The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although L-asparaginase (L-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of L-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus L-asp (N = 22) or combination chemotherapy without L-asp (N = 48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. After a median follow-up period of 12.8 months (range, 1.1-186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus L-asp compared to those treated with chemotherapy without L-asp (overall response rate, 90.0 vs. 34.8 %, P < 0.001; complete remission rate, 65.0 vs. 21.7 %, P = 0.001). The OS and PFS were significantly higher for the IMEP plus L-asp group compared with the chemotherapy without L-asp group. In a multivariate analysis, the use of chemotherapy without L-asp was an independent predictor of reduced OS (hazards ratio (HR) = 2.18, 95 % confidence interval (CI) 1.08-4.40; P = 0.030) and PFS (HR = 2.29, 95 % CI 1.22-4.29; P = 0.010). IMEP plus L-asp is active against stage III/IV NTCL, and it is an independent predictor of improved survival.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
authors.forename: Miso
authors.initials: M
authors.lastname: Kim
authors.forename: Tae Min
authors.initials: TM
authors.lastname: Kim
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Bhumsuk
authors.initials: B
authors.lastname: Keam
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Kim
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Jeon
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Kim
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005047:Etoposide; D011239:Prednisolone; D001215:Asparaginase; D007069:Ifosfamide; D008727:Methotrexate