Phase II trial of concurrent chemoradiotherapy with L-asparaginase and MIDLE chemotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma, nasal type (CISL-1008)

Dok Hyun Yoon, Seok Jin Kim, Seong Hyun Jeong, Dong Yeop Shin, Sung Hwa Bae, Junshik Hong, Seong Kyu Park, Ho Young Yhim, Deok Hwan Yang, Hyewon Lee, Hye Jin Kang, Mark Hong Lee, Hyeon Seok Eom, Jae Yong Kwak, Jae Hoon Lee, Cheolwon Suh, Won Seog Kim

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22 Scopus citations

Abstract

We designed a new treatment protocol incorporating concurrent administration of L-asparaginase (to reduce the probability of systemic progression during concurrent chemoradiotherapy (CCRT)) plus high-dose methotrexate to consolidation chemotherapy to intensify the regimen for treating localized extranodal NK/T cell lymphoma, nasal type (ENKTL). CCRT comprised radiation (36-44 Gy) with weekly cisplatin (30 mg/m2) and tri-weekly L-asparaginase (4 000 IU). Chemotherapy-MIDLE (methotrexate 3 g/m2 on day 1, etoposide 100 mg/m2 and Ifosfamide 1 000 mg/m2 on days 2-3, dexamethasone 40 mg on days 1-4, and L-asparaginase 6 000 IU/m2 on days 4, 6, 8, 10)-was repeated every 28 days for two cycles. One of the 28 patients developed distant lesions after CCRT. The final complete response rate was 82.1%. Four patients dropped out during or after their first MIDLE cycle due to toxicities (recurrent G3 hyperbilirubinemia [n = 1], G3-5 increased creatinine [n = 2], and G5 infection [n = 1]). With a median follow-up of 46 months (95% CI: 39-47 months), the estimated 3-year progression-free survival rate and overall survival rate were 74.1% and 81.5%, respectively. This MIDLE protocol may be effective for localized ENKTL. However, concurrent administration of L-asparaginase during CCRT does not seem to provide additional benefits.

Original languageEnglish (US)
Pages (from-to)85584-85591
Number of pages8
JournalOncotarget
Volume7
Issue number51
DOIs
StatePublished - 2016

Keywords

  • Concurrent chemoradiotherapy
  • Extranodal NK/T-cell lymphoma
  • L-asparaginase
  • Methotrexate
  • Nasal type
  • Treatment

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