Long‐term outcomes and central nervous system relapse in extranodal natural killer/T‐cell lymphoma
Long‐term outcomes and central nervous system relapse in extranodal natural killer/T‐cell lymphoma
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结外自然杀伤/T细胞淋巴瘤的长期结局和中枢神经系统复发
DOI：
10.1002/hon.2977
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发表时间：
2022
期刊：
影响因子：
3.3
通讯作者：
Yamaguchi M
中科院分区：
文献类型：
--
作者：
Miyazaki K;Suzuki R;Oguchi M;Taguchi S;...;Yamaguchi M
为了阐明不含蒽环类抗生素治疗和中枢神经系统（CNS）事件在鼻型结源性NK/T细胞淋巴瘤（ENKTL）患者中的长期结局，更新并分析了2000年至2013年在日本进行的一项全国性回顾性研究中诊断的313例ENKTL患者的临床数据。在中位随访8.4年时，140例在临床实践中接受放疗-地塞米松、依托泊苷、异环磷酰胺和卡铂（RT‐DeVIC）的局限性ENKTL患者的5年总生存期（OS）和无进展生存期（PFS）分别为71%和64%。9例（6.4%）患者发生了第二次恶性肿瘤。在155例接受RT‐DeVIC治疗的局限性ENKTL患者中，10例（6.5%）发生CNS复发（中位时间，诊断后12.8个月）。其中5例事件仅限于CNS。10例CNS复发患者中有9例在CNS复发后1年内死亡。多变量分析确定牙龈（风险比[HR]，54.35; 95%置信区间[CI]，8.60-343.35）和鼻旁受累（HR，7.42; 95% CI，1.78-30.89）为CNS复发的独立风险因素。在80例晚期ENKTL患者中，18例接受类固醇（地塞米松）、甲氨蝶呤、异环磷酰胺、L-天冬酰胺酶和依托泊苷（SMILE）化疗作为一线治疗。接受SMILE一线治疗的患者的OS往往优于未接受SMILE一线治疗的患者（p= 0.071）。6例（7.5%）晚期ENKTL患者发生了孤立性CNS复发（中位，诊断后2.6个月），并在复发后4个月内死亡。在晚期ENKTL患者中没有记录到第二种恶性肿瘤。在整个队列中，首次复发或进展后的中位OS为4.6个月。PFS事件后存活5年的12例患者在末次随访时无疾病。其中11例（92%）接受了造血干细胞移植。我们的8年随访显示了RT‐DeVIC和SMILE的长期疗效和安全性。CNS复发的风险是晚期ENKTL的重要考虑因素。
To elucidate the long‐term outcomes of non‐anthracycline‐containing therapies and central nervous system (CNS) events in patients with extranodal NK/T‐cell lymphoma, nasal type (ENKTL), the clinical data of 313 patients with ENKTL diagnosed between 2000 and 2013 in a nationwide retrospective study in Japan were updated and analyzed. At a median follow‐up of 8.4 years, the 5‐year overall survival (OS) and progression‐free survival (PFS) were 71% and 64%, respectively, in 140 localized ENKTL patients who received radiotherapy‐dexamethasone, etoposide, ifosfamide, and carboplatin (RT‐DeVIC) in clinical practice. Nine (6.4%) patients experienced second malignancies. In 155 localized ENKTL patients treated with RT‐DeVIC, 10 (6.5%) experienced CNS relapse (median, 12.8 months after diagnosis). In five of them, the events were confined to the CNS. Nine of the 10 patients who experienced CNS relapse died within 1 year after CNS relapse. Multivariate analysis identified gingival (hazard ratio [HR], 54.35; 95% confidence interval [CI], 8.60–343.35) and paranasal involvement (HR, 7.42; 95% CI, 1.78–30.89) as independent risk factors for CNS relapse. In 80 advanced ENKTL patients, 18 received steroid (dexamethasone), methotrexate, ifosfamide, L‐asparaginase, and etoposide (SMILE) chemotherapy as first‐line treatment. Patients who received SMILE as their first‐line treatment tended to have better OS than those who did not (p= 0.071). Six (7.5%) advanced ENKTL patients experienced isolated CNS relapse (median, 2.6 months after diagnosis) and died within 4 months of relapse. No second malignancies were documented in advanced ENKTL patients. In the entire cohort, the median OS after first relapse or progression was 4.6 months. 12 patients who survived 5 years after PFS events were disease‐free at the last follow‐up. Of those, 11 (92%) underwent hematopoietic stem cell transplantation. Our 8‐year follow‐up revealed the long‐term efficacy and safety of RT‐DeVIC and SMILE. The risk of CNS relapse is an important consideration in advanced ENKTL.
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