Background: Combination chemotherapy consisting of ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) was active as first-line and second-line treatment for extranodal natural killer/T-cell lymphoma (NTCL).
Methods: Forty-four patients with chemo-naïve stage I/II NTCL were enrolled in a prospective, multicenter, phase II study and received six cycles of IMEP (ifosfamide 1.5 g/m(2) on days 1-3; methotrextate 30 mg/m(2) on days 3 and 10; etoposide 100 mg/m(2) on days 1-3; and prednisolone 60 mg/m(2) per day on days 1-5) followed by involved field radiotherapy (IFRT).
Results: Overall response rates were 73% (complete remission [CR] in 11 of 41 evaluable patients [27%]) after IMEP chemotherapy and 78% (CR 18 of 27 evaluable patients [67%]) after IMEP followed by IFRT. Neutropenia and thrombocytopenia were documented in 33 patients (75%) and 7 patients (16%), respectively. Only 8 patients (18%) experienced febrile neutropenia. Three-year progression-free survival (PFS) and overall survival (OS) were 66% and 56%, respectively. High Ki-67 (≥70%) and Ann Arbor stage II independently reduced PFS (p = .004) and OS (p = .001), respectively.
Conclusion: Due to the high rate of progression during IMEP chemotherapy, IFRT needs to be introduced earlier. Moreover, active chemotherapy including an l-asparaginase-based regimen should be use to reduce systemic treatment failure in stage I/II NTCL.
摘要
背景. 异环磷酰胺、甲氨蝶呤、依托泊苷以及泼尼松龙（IMEP）联合化疗是结外鼻型自然杀伤/T 细胞淋巴瘤（NTCL）的有效一线和二线治疗。
方法. 本次前瞻性、多中心、 II 期研究入组 44 例既往未接受过化疗的 I/II 期 NTCL 患者，给予 IMEP 6 周期治疗（异环磷酰胺 1.5 mg/m2，第 1∼3 天；甲氨蝶呤 30 mg/m2，第 3、10 天；依托泊苷 100 mg/m2，第 1∼3 天；泼尼松龙 60 mg/m2，第 1∼5 天），继以受累野放疗（IFRT）。
结果. IMEP 化疗后，总缓解率为 73%[11/41 例可评估患者完全缓解（CR，27%）]，IMEP 继以 IFRT 后，总缓解率为 78%[18/27 例可评估患者 CR（67%）]。确认的中性粒细胞减少和血小板减少分别为 33 例（75%）和 7 例（16%）。仅 8 例患者（18%）发生发热性中性粒细胞减少。3 年无进展生存（PFS）率和总生存（OS）率分别为 66% 和 56%。高Ki-67（≥ 70%）和 Ann Arbor II 期与 PFS（p=0.004）和 OS（p=0.001）较短独立相关。
结论. 由于 IMEP 化疗期间疾病进展率很高，IFRT 需要早期给予。而且，应该使用包括基于左旋门冬酰胺酶的方案在内的有效化疗，以减少 I/II 期 NTCL 的系统性治疗失败。The Oncologist 2014;19: 1129-1130
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