Efficacy of a short sandwich protocol, methotrexate, gemcitabine, L‐asparaginase and dexamethasone chemotherapy combined with radiotherapy, in localised newly diagnosed NK/T‐cell lymphoma: A French retrospective study

Abstract

Extranodal NK/T-cell lymphoma, nasal type is a rare and aggressive form of lymphoma, historically associated with poor prognosis. We report here the results of a retrospective multi-centre study evaluating the efficacy of MGAD (methotrexate, gemcitabine, L-asparaginase and dexamethasone) regimen (two cycles) combined with 'sandwich' radiotherapy in 35 patients with localised newly diagnosed extranodal NK/T-cell lymphoma. Thirty-two patients (91%) reached complete remission. With a long median follow-up of 59.6 months, progression-free and overall survival at 2 and 5 years were 71%, 80% and 53%, 73%, respectively. Around one third of the patients experienced relapse within a median time of 14.5 months. Side-effects were manageable with grades 3-4 cytopenias, mucositis and infection in 50%, 24% and 21% of the cases, respectively. Monitoring of asparaginase activity was performed in 13 patients and showed inactivation of the drug in seven (54%) patients. Our results indicate that a short therapy by sandwich MGAD chemoradiotherapy is a tolerable and effective treatment option in localised newly diagnosed extranodal NK/T-cell lymphoma patients.

How molecular advances may improve the diagnosis and management of PTCL patients

“…Better efficacy and tolerance have been observed with the use of pegasparaginase relative to L-asparaginase (223,224). Although there is no international consensus concerning the treatment sequence, it is generally accepted that frontline therapy should include at least pegylated-asparaginase and gemcitabine in association with various combination of other agents or strategies (including cisplatin/oxaliplatin, dexamethasone, methotrexate, and radiotherapy), depending on the staging of the lymphoma as localized or disseminated disease (223)(224)(225)(226).…”