Midline NK/T-cell lymphoma nasal-type: treatment outcome, the effect of L-asparaginase based regimen, and prognostic factors

PURPOSE: Midline NK/T-cell lymphoma nasal-type is an aggressive neoplasm with poor prognosis in most instances. To improve the treatment outcome, we have tried using L-asparaginase based regimen as salvage regimen plus radiation in CHOP failures, and report here the therapeutic results and prognostic factors. PATIENTS AND METHODS: From March 1992 to January 2005, 46 Chinese patients with midline NK/T-cell lymphoma nasal-type were initially treated with CHOP regimen as first-line chemotherapy. The patients who failed CHOP regimens were altered to receive L-asparaginase based salvage regimen. All the patients received primary involved-field radiation after chemotherapy. RESULTS: Thirteen patients (28.3%) sensitive to CHOP regimen received CHOP regimen for 6 cycles plus locoregional radiation, and achieved complete remission (CR). Thirty-three patients failed CHOP regimen were altered to received L-asparaginase-based salvage regimen for 2 approximately 6 cycles (median 3 cycles) plus locoregional radiation, and seventeen of the 33 CHOP failures (51.5 %) (L-asparaginase group) reached CR. The CR rate for the whole group was 65.2% (30/46 cases). The 5-year overall survival (OS) rates were 64.5% for the whole group and 55.9% for L-asparaginase group, respectively. On univariate analysis, disease stage, fever symptom and performance status were significant factors influencing overall survival. On multivariate analysis, only disease stage and fever symptom remained as independently significant factors influencing OS. CONCLUSION: In this preliminary study, the results indicated that L-asparaginase based regimen might be a promising new salvage chemotherapeutic regimen in CHOP failures and conduce to improve the treatment outcome in midline NK/T-cell lymphoma, nasal-type.