A phase 2 study of methotrexate, etoposide, dexamethasone, and pegaspargase chemotherapy for newly diagnosed, relapsed, or refractory extranodal natural killer/T-cell lymphoma, nasal type: a multicenter trial in Northwest China

Hematol Oncol. 2017 Dec;35(4):619-629. doi: 10.1002/hon.2325. Epub 2016 Oct 10.

Abstract

The nasal type of extranodal natural killer/T-cell lymphoma is a rare aggressive lymphoma with poor prognosis. To discover a successful treatment, we investigated the efficacy and safety of chemotherapy with methotrexate, etoposide, dexamethasone, and polyethylene glycol-asparaginase (MESA). Three cycles of MESA were administered to 46 patients with new or relapsed/refractory natural killer/T-cell lymphoma. Complete response after 3 treatment cycles was 43.5%, the overall response rate was 87%, and 2-year overall survival was 83.4%. Complete response was significantly better for newly diagnosed patients than for patients with relapsed/refractory disease. Patients with newly diagnosed disease had a significantly better overall response rate after 1, but not after 2 or 3 treatment cycles. Overall survival and progression-free survival did not differ over 2 years. Grade 1/2 toxicities were frequent, but MESA was associated with fewer grade 3/4 events or treatment-related deaths. These results will require confirmation in larger prospective trials.

Keywords: chemotherapy; clinical trial; extranodal NK/T-cell lymphoma; lymphoma; nasal type; non-Hodgkin; refractory; relapse.

Publication types

  • Clinical Trial, Phase II
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Asparaginase / administration & dosage
  • Biomarkers
  • China
  • Dexamethasone / administration & dosage
  • Drug Resistance, Neoplasm
  • Etoposide / administration & dosage
  • Female
  • Humans
  • Immunophenotyping
  • Kaplan-Meier Estimate
  • Lymphoma, Extranodal NK-T-Cell / diagnosis*
  • Lymphoma, Extranodal NK-T-Cell / drug therapy*
  • Lymphoma, Extranodal NK-T-Cell / mortality
  • Male
  • Methotrexate / administration & dosage
  • Middle Aged
  • Neoplasm Staging
  • Polyethylene Glycols / administration & dosage
  • Prognosis
  • Recurrence
  • Retreatment
  • Treatment Outcome
  • Young Adult

Substances

  • Biomarkers
  • Polyethylene Glycols
  • Etoposide
  • pegaspargase
  • Dexamethasone
  • Asparaginase
  • Methotrexate