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Oncologist. 2014 Nov;19(11):1129-30. doi: 10.1634/theoncologist.2014-0305. Epub 2014 Oct 3.

A phase II study of ifosfamide, methotrexate, etoposide, and prednisolone for previously untreated stage I/II extranodal natural killer/T-cell lymphoma, nasal type: a multicenter trial of the Korean Cancer Study Group.

Author information

1
Seoul National University Hospital, Seoul, Republic of Korea;
2
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;
3
Pusan National University Hospital, Busan, Republic of Korea;
4
Keimyung University Dongsan Medical Center, Daegu, Republic of Korea;
5
Hallym University Sacred Heart Hospital, Seoul, Republic of Korea;
6
Korea University Medical Center, Seoul, Republic of Korea;
7
Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea;
8
Ulsan University Hospital, Ulsan, Republic of Korea;
9
Korea Cancer Center Hospital, Seoul, Republic of Korea;
10
Inje University Sanggye Paik Hospital, Seoul, Republic of Korea;
11
Daegu Catholic University Medical Center, Daegu, Republic of Korea;
12
Yeungnam University College of Medicine, Daegu, Republic of Korea.
13
Seoul National University Hospital, Seoul, Republic of Korea; heo1013@snu.ac.kr.

Abstract

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.

PMID:
25280488
PMCID:
PMC4221378
DOI:
10.1634/theoncologist.2014-0305
[Indexed for MEDLINE]
Free PMC Article

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