Intensive therapy can improve long‐term survival in newly diagnosed, advanced‐stage extranodal NK/T‐cell lymphoma: A multi‐institutional, real‐world study

Abstract The study investigated the treatment and prognosis of advanced‐stage extranodal natural killer/T‐cell lymphoma (ENKTL). With a median follow‐up of 75.03 months, the median overall survival (mOS) for the 195 newly diagnosed stage III/IV ENKTL patients was 19.43 months, and estimated 1‐, 2‐, 3‐ and 5‐year OS were 59.5%, 46.3%, 41.8% and 35.1%, respectively. Chemotherapy (CT) + radiotherapy (RT) compared to CT alone ( P = .007), and hematopoietic stem cell transplantation (HSCT) compared to non‐HSCT ( P < .001), both improved OS. For patients ≤60 years and ineligible for HSCT, other therapies with complete remission led to comparable OS ( P = .141). Nine patients ever treated with chidamide achieved a median progression‐free survival (mPFS) and mOS of 53.63 (range, 3.47‐92.33) and 54.80 (range, 5.50‐95.70) months, and four with chidamide maintenance therapy (MT) achieved a mPFS and mOS of 55.83 (range, 53.27‐92.33) and 60.65 (range, 53.70‐95.70) months, possibly providing an alternative option for non‐HSCT patients. Non‐anthracycline (ANT)‐ compared to ANT‐, asparaginase (Aspa)‐ compared to non‐Aspa‐ and gemcitabine (Gem)‐ compared to non‐Gem‐based regimens, prolonged PFS ( P = .031; P = .005; P = .009) and OS ( P = .010; P = .086; P = .003), respectively. Multivariate analysis demonstrated that Gem‐based regimens improved PFS (HR = 0.691, P = .061) and OS (HR = 0.624, P = .037). Gem + Aspa combinations slightly improved PFS and OS compared to regimens containing Gem or Aspa alone ( P > 0.05). First‐line “intensive therapy,” including CT (particularly Gem + Aspa regimens), RT, HSCT and alternative chidamide MT, was proposed and could improve long‐term survival for advanced‐stage ENKTLs. Ongoing prospective clinical studies may shed further light on the value of chidamide MT.