TOPLINE

Upfront autologous stem cell transplantation (ASCT) consolidation is associated with improved progression-free survival (PFS) in patients with advanced-stage extranodal natural killer/T-cell lymphoma (NKTCL) who achieve a first complete remission after frontline therapy. Among 107 patients studied, those receiving ASCT had a 3-year PFS rate of 78.2% compared with 54.6% in the non-ASCT group.

METHODOLOGY

• The specific survival benefit of consolidating with ASCT, especially for patients achieving complete remission after first-line chemotherapy, remains a subject of ongoing debate. A consensus on the most effective treatment strategy for advanced-stage NKTCL has not been reached.
• Researchers conducted a multicenter retrospective study involving 107 patients diagnosed with stage III or IV NKTCL who achieved first complete remission after frontline treatment between 2006 and 2023 at 14 medical centers in China.
• A total of 38 patients (36%) received upfront ASCT consolidation at the time of first complete remission, while 69 patients (64%) did not receive ASCT. The majority of patients (87%) received non-anthracycline-based first-line chemotherapy, and 54 patients (51%) received local radiotherapy as part of frontline treatment.
• Primary endpoints were PFS, measured from diagnosis to first progression, relapse, or death, and overall survival (OS), defined as the time from diagnosis to death or last follow-up.
• Propensity score matching analysis was performed to adjust for potential selection bias between the ASCT and non-ASCT groups, matching baseline prognostic index for NK lymphoma score, types of chemotherapy regimens, and use of local radiotherapy.

TAKEAWAY

• Patients receiving upfront ASCT demonstrated significantly better 3-year PFS rates compared with the non-ASCT group (78.2% vs 54.6%; P = .005) and better 3-year OS rates (86.0% vs 68.9%; P = .04).
• In multivariate analysis, upfront ASCT was an independent predictor of better PFS (hazard ratio [HR], 0.37; P = .025) but not OS (HR, 0.39; P = .101).
• Among patients receiving non-anthracycline-based chemotherapy, ASCT was associated with significantly better 3-year PFS (77.6% vs 59.3%; P = .025) but not OS (85.6% vs 74.8%; P = .164).
• After propensity score matching, ASCT remained significantly associated with better PFS (3-year rate: 80.6% vs 56.9%; P = .032) but not OS (84.6% vs 68.9%; P = .141).

IN PRACTICE

“These real-world data suggest upfront ASCT prolongs PFS in patients with advanced-stage NKTCL in CR1, yet its impact on OS remains unclear,” wrote the authors of the study.

SOURCE

The study was led by Shaoxuan Hu, Weiping Liu, Shunan Qi, and Yuqin Song, of Peking University Cancer Hospital & Institute in Beijing, China. It was published online in the American Journal of Hematology.

LIMITATIONS

The study is limited by its retrospective design and inherent physician bias regarding treatment selection. The relatively limited sample size may compromise the statistical power of certain subgroup analyses, especially for OS benefit outcomes associated with ASCT. Imbalances in risk factors between the ASCT and non-ASCT groups, such as radiotherapy and chemotherapy regimens, were observed, though statistical methods including multivariate and propensity score matching analyses were employed to adjust for these imbalances. Owing to the wide time span of the study (2006-2023), data on peripheral blood Epstein-Barr virus DNA were unavailable for a large proportion of patients; thus, blood Epstein-Barr virus DNA was not included in the survival analyses.

DISCLOSURES

The research received funding from Capital’s Funds for Health Improvement and Research (No. 2024-1-2151), Beijing Municipal Administration of Hospitals Incubating Program (Grant No. PX2024038), Science Foundation of Peking University Cancer Hospital (No. ZY202401), and the Wu Jieping Medical Foundation (No. 320.6750.2024-17-54). No conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.