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Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus l-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL)

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Abstract

The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although l-asparaginase (l-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of l-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus l-asp (N = 22) or combination chemotherapy without l-asp (N = 48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. After a median follow-up period of 12.8 months (range, 1.1–186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus l-asp compared to those treated with chemotherapy without l-asp (overall response rate, 90.0 vs. 34.8 %, P < 0.001; complete remission rate, 65.0 vs. 21.7 %, P = 0.001). The OS and PFS were significantly higher for the IMEP plus l-asp group compared with the chemotherapy without l-asp group. In a multivariate analysis, the use of chemotherapy without l-asp was an independent predictor of reduced OS (hazards ratio (HR) = 2.18, 95 % confidence interval (CI) 1.08–4.40; P = 0.030) and PFS (HR = 2.29, 95 % CI 1.22–4.29; P = 0.010). IMEP plus l-asp is active against stage III/IV NTCL, and it is an independent predictor of improved survival.

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Acknowledgments

This work was supported by a grant from the Innovative Research Institute for Cell Therapy, Republic of Korea (A062260). We thank Juyoun Kim for the assistance with clinical data collection.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Miso Kim, Tae Min Kim, Bhumsuk Keam, Se-Hoon Lee, Dong-Wan Kim & Dae Seog Heo

  2. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea

    Ki Hwan Kim

  3. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Jong Seok Lee

  4. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Yoon Kyung Jeon & Chul Woo Kim

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  1. Miso Kim
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Correspondence to Tae Min Kim.

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Kim, M., Kim, T.M., Kim, K.H. et al. Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus l-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL). Ann Hematol 94, 437–444 (2015). https://doi.org/10.1007/s00277-014-2228-4

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