title: Effectiveness of pegaspargase, gemcitabine, and oxaliplatin (P-GEMOX) chemotherapy combined with radiotherapy in newly diagnosed, stage IE to IIE, nasal-type, extranodal natural killer/T-cell lymphoma.
abstract: OBJECTIVE
  Extranodal natural killer/T-cell lymphoma (ENKTL), nasal-type, is a distinct subtype of non-Hodgkin lymphoma. ENKTL is sensitive to radiotherapy, but the prognosis is poorer than those of other types of early stage lymphoma. To date, optimal treatment strategies for patients with early stage ENKTL have not been fully defined.
  
  
  METHODS
  We retrospectively investigated the efficacy and safety of pegaspargase, gemcitabine, and oxaliplatin (P-GEMOX) combined with different dose radiotherapy (RT) in the treatment of 35 newly diagnosed, stage IE to IIE ENKTL patients at our institution from October 2011 to September 2015. All patients were treated with RT (<54 Gy or ≥54 Gy) after an initial two cycles of P-GEMOX, and following two consolidation cycles. The primary endpoints were objective response rate and complete remission rate (CR). The secondary endpoints were 2-year overall survival (OS), 2-year progression-free survival (PFS), and toxicity.
  
  
  RESULTS
  Thirty-three patients completed total therapy, which resulted in 94.3% of response rate that included 28 patients (80.0%) with CR and five patients (14.3%) with partial response (PR). Two (5.7%) patients progressed during therapy and six (17.1%) progressed during follow-up. The 2-year OS was 82.9%, and the 2-year PFS was 77.1%. Patients with CR, low circulating EBV DNA load (≤6.1 × 107copies/ml), low NKIPI (score 0-1), and high RT dose (≥54 Gy) were independent predictors of better prognosis. Grade 3 toxicities were few; only four (11.4%) patients experienced grade 4 toxicities. No treatment-related deaths were observed.
  
  
  CONCLUSIONS
  The research showed that the treatment of P-GEMOX combined with RT was a tolerable and effective treatment for localized nasal natural killer/T-cell lymphoma.
authors.affiliation: a Department of Chemotherapy , Sichuan Cancer Hospital , Chengdu , China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wei
authors.affiliation: a Department of Chemotherapy , Sichuan Cancer Hospital , Chengdu , China.
authors.forename: Ping
authors.initials: P
authors.lastname: Wu
authors.affiliation: a Department of Chemotherapy , Sichuan Cancer Hospital , Chengdu , China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: a Department of Chemotherapy , Sichuan Cancer Hospital , Chengdu , China.
authors.forename: Zhi-Hui
authors.initials: ZH
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001215:Asparaginase / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011092:Polyethylene Glycols / Q000008:administration & dosage; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D003841:Deoxycytidine; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase; D000093542:Gemcitabine
keywords: Lymphoma; P-GEMOX (pegaspargase; and gemcitabine); chemotherapy; extranodal NK-T-Cell; oxaliplatin; radiotherapy