Clinical efficacy of cisplatin, dexamethasone, gemcitabine and pegaspargase (DDGP) in the initial treatment of advanced stage (stage III–IV) extranodal NK/T-cell lymphoma, and its correlation with Epstein-Barr virus

Figures & data

Table 1 Baseline data of all patients (n=64)

Parameters	No. of cases	%
Age/year
Median age	40
Range	8–68
Gender
Male	40	62.5
Female	24	37.5
ENKL type
UAT	52	81.2
NUAT	12	18.8
B symptom
Yes	38	59.4
No	26	40.6
EBV infection
Positive	28	75.0
Negative	36	25.0
Staging
Stage III	30	46.9
Stage IV	34	53.1
LDH
Normal	39	60.9
Increase	25	39.1
PS score
0	11	17.2
1	34	53.1
2	17	26.6
3	2	3.1
IPI
0–1	5	7.8
2	29	45.3
3	18	28.1
4	12	18.8

Abbreviations: ENKTL, extranodal NK/T-cell lymphoma, nasal type; UAT, upper airway tract; NUAT, nonupper airway tract; EBV, Epstein-Barr virus; LDH, lactate dehydrogenase; PS, physical strength; IPI, international prognostic index.

Table 2 DDGP regime-induced adverse reactions

Toxicity	Grade of adverse reaction
	0–2		3–4
	No. %		No. %
Hematologic
Leukopenia	26	40.6	31	48.4
Neutropenia	24	37.5	31	48.4
Anemia	40	62.5	16	25.0
Thrombocytopenia	21	32.8	27	42.2
Coagulation disorders
Hypofibrinogenemia	24	37.5	0	0
Prolonged APTT	20	31.3	0	0
Others
Digestive tract effect	42	65.6	8	12.5
Liver dysfunction	23	35.9	1	1.6
Increased BUN	4	6.3	0	0
Increased β2-MG	21	32.8	0	0
Allergy	0	0	0	0
Baldness	20	31.3	8	12.5

Abbreviations: APTT, activated partial thromboplastin time; BUN, blood urea nitrogen; β2-MG, β2-microglobulin.

Figure 1 PFS of 64 patients and OS of 55 patients after DDGP regime chemotherapy. (A) The 1-, 2- and 3-year PFS was 77.00%, 67.80% and 62.00%, respectively. (B) The 1-, 2- and 3-year OS was 81.50% 74.9% and 74.90%, respectively.

Abbreviations: DDGP, cisplatin, dexamethasone, gemcitabine and pegaspargase; OS, overall survival; PFS, progression-free survival.

Figure 2 Survival curves. (A) PFS is shown for all patients. No significant difference was noted in PFS between the EBV-DNA-positive group and EBV-DNA-negative group. (P=0.812). (B) OS is shown for 55 patients, the EBV-DNA-negative group has a better OS than EBV-DNA-positive group (P=0.046).

Abbreviations: DDGP, cisplatin, dexamethasone, gemcitabine and pegaspargase; EPV, Epstein-Barr virus; OS, overall survival; PFS, progression-free survival.

Figure 3 Comparison of PFS and OS curves between patients negative and positive for EBV in the EBV (+) group. (A) Progression-free survival (PFS) is shown for 28 patients negative for EBV (+) group, showing the turned to negative group has a better PFS than remained positive group (P=0.003). (B) OS is shown for 25 patients negative for EBV (+) group, showing the turned to negative group has a better OS than remained positive group (P=0.017).

Abbreviations: DDGP, cisplatin, dexamethasone, gemcitabine and pegaspargase; EPV, Epstein-Barr virus; OS, overall survival; PFS, progression-free survival.

Table 3 Comparison of pegaspargase- or L-asparaginase- or gemcitabine-based regimens in the treatment of extranodal NK/T-cell lymphoma

Disease status	No.	Treatment	Response		Survival		Adverse effects		Reference
ORR CR		OS PFS		Grade 3/4 neutropenia	Grade 3/4 hepatotoxicity
Newly diagnosed, advanced-stage	64	DDGP	79.69%	60.94%	1y: 81.50% 2y: 74.9% 3y: 74.9%	1y: 77.00% 2y: 67.80% 3y: 62.00%	48.4%	1.6%	This study
Newly diagnosed, advanced-stage or relapsed/refractory	35	P-gemox ± sandwiched RT (50Gy)	80%	51.4%	76.8%	45.0%	40%	11.5%	34
Newly diagnosed, advanced-stage or relapsed/refractory	7	SMILE	67%	50%	–	–	One patient	Two patients	35
Newly diagnosed stage IV, relapsed/refractory	38	SMILE	79%	45%	1y: 55%	1y: 53%	100%	32%%	36
Relapsed/refractory	19	AspaMetDex	78%	61%	2y: 40%	2y: 40%	42%	16%	37

Abbreviations: ORR, overall response rate; CR, complete remission; OS, overall survival; PFS, progression-free survival; DDGP, cisplatin, dexamethasone, gemcitabine and pegaspargase; RT, radiotherapy; y, year; P-gemox, pegaspargase, gemcitabine and oxaliplatin; SMILE, dexamethasone, methotrexate, ifosfamide, L-asparaginase and etoposide; AspaMetDex, L-asparaginase, methotrexate, and dexamethasone.