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An asparaginase-based regimen produced a response in four out of five people with an aggressive nasal lymphoma that resists ordinary chemotherapy, and nearly all of them developed dangerously low white cell counts.
A phase 2 study of the SMILE regimen, comprising dexamethasone, methotrexate, ifosfamide, L-asparaginase and etoposide, in patients with newly diagnosed stage IV, relapsed or refractory extranodal natural killer/T-cell lymphoma, nasal type, and performance status 0 to 2. Two cycles were given as the protocol treatment and the primary endpoint was the overall response rate afterwards.
38 eligible patients were enrolled, with a median age of 47 (range 16 to 67) and a male to female ratio of 21 to 17. Twenty had newly diagnosed stage IV disease, 14 were in first relapse and four were primary refractory. The first two patients died from infections, after which eligibility was revised to require a lymphocyte count of 500 per microlitre or more; no treatment-related deaths occurred after the revision. The overall response rate was 79 per cent (90 per cent confidence interval 65 to 89) and the complete response rate 45 per cent. Of the 28 patients who completed the protocol treatment, 19 underwent haematopoietic stem-cell transplantation. One-year overall survival was 55 per cent (95 per cent confidence interval 38 to 69). Grade 4 neutropenia occurred in 92 per cent and grade 3 or 4 infection in 61 per cent.
The regimen that made extranodal NK/T-cell lymphoma treatable. The usual explanation is that asparaginase is not a substrate of the P-glycoprotein pump this tumour expresses, which would explain why it works where anthracycline-based regimens do not; that mechanism is widely repeated but has been contradicted by at least one series.
Shares Complete response, Randomised evidence for the T-cell lymphomas, including the ones that are not in Europe or North America, Etoposide, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma) and the tag lymphoma-evidence.
Shares Complete response, Randomised evidence for the T-cell lymphomas, including the ones that are not in Europe or North America, Etoposide, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma) and the tag lymphoma-evidence.
Shares The drugs that cure lymphoma, and the places that do not have them, Rare and paediatric cancers without markets, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Most of the world has almost no cancer care and the tag lymphoma-evidence.
Shares Complete response, Objective response rate (ORR), Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Journal of Clinical Oncology and the tag lymphoma-evidence.
Shares Complete response, Objective response rate (ORR), Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Most of the world has almost no cancer care and the tag lymphoma-evidence.
Shares Autologous stem cell transplant (ASCT), Methotrexate, Rare and paediatric cancers without markets, Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting and the tag lymphoma-evidence.
Shares Complete response, Objective response rate (ORR), Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Non-Hodgkin lymphoma (all types) and the tag lymphoma-evidence.
Shares Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma), Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting, Most of the world has almost no cancer care, Non-Hodgkin lymphoma (all types) and the tag lymphoma-evidence.