High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project
Abstract Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study a...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2022-11-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-022-25034-3 |
| _version_ | 1811207932934619136 |
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| author | Luís Alberto de Pádua Covas Lage Pedro Paulo Faust Machado Cadiele Oliana Reichert Eliana Miranda Hebert Fabrício Culler Sheila Aparecida Coelho da Siqueira Renata de Oliveira Costa Dênis Ricardo Miyashiro José Antônio Sanches Vanderson Rocha Carlos Sérgio Chiattone Juliana Pereira |
| author_facet | Luís Alberto de Pádua Covas Lage Pedro Paulo Faust Machado Cadiele Oliana Reichert Eliana Miranda Hebert Fabrício Culler Sheila Aparecida Coelho da Siqueira Renata de Oliveira Costa Dênis Ricardo Miyashiro José Antônio Sanches Vanderson Rocha Carlos Sérgio Chiattone Juliana Pereira |
| author_sort | Luís Alberto de Pádua Covas Lage |
| collection | DOAJ |
| description | Abstract Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study aims to report clinical characteristics, prognostic factors, and outcomes in a multicenter cohort of ENKTL patients from Brazil. This retrospective, observational and multicenter study included 98 ENKTL patients treated during two decades in Brazil. Data were extracted from the T-Cell Brazil Project database. In our cohort, 59/98 patients (60.2%) were male, with a median age of 50 years. Sixty-two patients (63.3%) had B-symptoms, 26/98 (26.5%) had Eastern Cooperative Oncology Group scale ≥ 2; 16/98 (16.3%) presented extranasal disease and 34.7% (34/98) were advanced-stage (Ann Arbor/Cotswolds III/IV). The median follow-up for the whole cohort was 49 months, with an estimated 2-year overall survival (OS) and progression-free survival (PFS) of 51.1% and 17.7%, respectively. In early-stage disease (IE/IIE), the median OS was 21.8 months for patients treated with concurrent radiotherapy plus chemotherapy (CCRT-VIPD [etoposide/vp-16, ifosfamide, cisplatin and dexamethasone), 16.2 months for sequential chemoradiotherapy (SCRT) followed by asparaginase-based regimens, and 56.7 months for SCRT followed by CHOP-like (cyclophosphamide, doxorrubicin, vincristine and prednisone) treatments, p = 0.211. CCRT was associated with higher rates of early-mortality, hematological toxicity, and mucositis. Median OS was 8.2 months for patients with advanced-stage disease receiving regimens containing asparaginase compared to 3.2 months for anthracycline-based therapy, p = 0.851. Chemo-radiotherapy (CRT) regimens demonstrated better OS (p = 0.001) and PFS (p = 0.007) than chemotherapy alone. Multivariate analysis revealed anemia, relapsed/refractory (R/R) disease and radiotherapy omission as poor outcome predictors for OS. Lymphopenia and radiotherapy omission adversely affected PFS. Concerning progression of disease within 24-months (POD-24), clinical stage III/IV was a poor outcome predictor. In this real-life Brazilian cohort, ENKTL presented dismal outcomes. Radiation therapy was an independent factor for increased OS and PFS, but CCRT regimens were associated with higher toxicities. Polychemotherapy based on anti-multi drug resistant agents was not associated with survival benefit in either early or advanced-stage disease in our patient cohort. |
| first_indexed | 2024-04-12T04:13:33Z |
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| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-04-12T04:13:33Z |
| publishDate | 2022-11-01 |
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| series | Scientific Reports |
| spelling | doaj.art-aa6aa79caf2c4bd7a4d8766dc2bc35a02022-12-22T03:48:27ZengNature PortfolioScientific Reports2045-23222022-11-0112111310.1038/s41598-022-25034-3High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil ProjectLuís Alberto de Pádua Covas Lage0Pedro Paulo Faust Machado1Cadiele Oliana Reichert2Eliana Miranda3Hebert Fabrício Culler4Sheila Aparecida Coelho da Siqueira5Renata de Oliveira Costa6Dênis Ricardo Miyashiro7José Antônio Sanches8Vanderson Rocha9Carlos Sérgio Chiattone10Juliana Pereira11Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine - University of São Paulo (FM-USP)Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine - University of São Paulo (FM-USP)Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP)Department of Hematology and Hemotherapy, University of Campinas (Unicamp)Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine - University of São Paulo (FM-USP)Department of Pathology, University of São Paulo (USP)Department of Hematology and Hemotherapy, Faculdade de Ciências Médicas de Santos (FCMS), Centro Universitário Lusíada (Unilus)Department of Dermatology, Faculty of Medicine – University of São Paulo (FM-USP)Department of Dermatology, Faculty of Medicine – University of São Paulo (FM-USP)Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine - University of São Paulo (FM-USP)Department of Hematology and Hemotherapy, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSC-SP)Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine - University of São Paulo (FM-USP)Abstract Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study aims to report clinical characteristics, prognostic factors, and outcomes in a multicenter cohort of ENKTL patients from Brazil. This retrospective, observational and multicenter study included 98 ENKTL patients treated during two decades in Brazil. Data were extracted from the T-Cell Brazil Project database. In our cohort, 59/98 patients (60.2%) were male, with a median age of 50 years. Sixty-two patients (63.3%) had B-symptoms, 26/98 (26.5%) had Eastern Cooperative Oncology Group scale ≥ 2; 16/98 (16.3%) presented extranasal disease and 34.7% (34/98) were advanced-stage (Ann Arbor/Cotswolds III/IV). The median follow-up for the whole cohort was 49 months, with an estimated 2-year overall survival (OS) and progression-free survival (PFS) of 51.1% and 17.7%, respectively. In early-stage disease (IE/IIE), the median OS was 21.8 months for patients treated with concurrent radiotherapy plus chemotherapy (CCRT-VIPD [etoposide/vp-16, ifosfamide, cisplatin and dexamethasone), 16.2 months for sequential chemoradiotherapy (SCRT) followed by asparaginase-based regimens, and 56.7 months for SCRT followed by CHOP-like (cyclophosphamide, doxorrubicin, vincristine and prednisone) treatments, p = 0.211. CCRT was associated with higher rates of early-mortality, hematological toxicity, and mucositis. Median OS was 8.2 months for patients with advanced-stage disease receiving regimens containing asparaginase compared to 3.2 months for anthracycline-based therapy, p = 0.851. Chemo-radiotherapy (CRT) regimens demonstrated better OS (p = 0.001) and PFS (p = 0.007) than chemotherapy alone. Multivariate analysis revealed anemia, relapsed/refractory (R/R) disease and radiotherapy omission as poor outcome predictors for OS. Lymphopenia and radiotherapy omission adversely affected PFS. Concerning progression of disease within 24-months (POD-24), clinical stage III/IV was a poor outcome predictor. In this real-life Brazilian cohort, ENKTL presented dismal outcomes. Radiation therapy was an independent factor for increased OS and PFS, but CCRT regimens were associated with higher toxicities. Polychemotherapy based on anti-multi drug resistant agents was not associated with survival benefit in either early or advanced-stage disease in our patient cohort.https://doi.org/10.1038/s41598-022-25034-3 |
| spellingShingle | Luís Alberto de Pádua Covas Lage Pedro Paulo Faust Machado Cadiele Oliana Reichert Eliana Miranda Hebert Fabrício Culler Sheila Aparecida Coelho da Siqueira Renata de Oliveira Costa Dênis Ricardo Miyashiro José Antônio Sanches Vanderson Rocha Carlos Sérgio Chiattone Juliana Pereira High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project Scientific Reports |
| title | High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project |
| title_full | High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project |
| title_fullStr | High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project |
| title_full_unstemmed | High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project |
| title_short | High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project |
| title_sort | high dose extended field radiotherapy plus chemotherapy improved survival in extranodal nk t cell lymphoma in a real life setting results from the multicenter t cell brazil project |
| url | https://doi.org/10.1038/s41598-022-25034-3 |
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