Clinical Analysis Of PD-1 Receptor Inhibitor Combined With P-Gemox-Dex Regimen In The Primary Treatment Of Phase Ⅲ/Ⅳ Extranodal Natural Killer/T Cell Lymphoma

Purpose1.To explore the treatment of programmed death-1(PD-1)inhibitor combined with gemcitabine,oxaliplatin,dexamethasone and pegaspase(P-Gemox-Dex)regimen for initial stage Ⅲ/Ⅳ Efficacy analysis of extranodal NK/T cell lymphoma(ENKTL);2.To explore the combination of PD-1 inhibitors combined with gemcitabine,oxaliplatin,dexamethasone and pegaspartase(P-Gemox-Dex)regimen for the treatment of newly treated stage Ⅲ/Ⅳ extranodal diseases Tolerability and adverse reactions of NK/T cell lymphoma;3.To investigate the clinical characteristics,survival and prognostic factors of newly treated patients with stage Ⅲ/Ⅳ extranodal NK/T cell lymphoma.MethodsA retrospective analysis of the clinical data of newly treated stage Ⅲ/Ⅳ extranodal NK/T cell lymphomas in the People’s Hospital of Zhengzhou University from November 2013 to October 2020 was divided into PD-1 inhibitor group and conventional chemotherapy group were analyzed and compared the clinical characteristics,treatment effects and adverse reactions of patients in different treatment regimens.The follow-up period ended in March 2021.Result1.A total of 36 patients were enrolled,9 in the PD-1 inhibitor group and 27 in the conventional chemotherapy group.The gender,age,presence or absence of B symptoms,ECOG score,IPI score,peripheral blood plasma LDH level,peripheral blood plasma β2-MG,Ki-67 index,and whether the lymphoma in the PD-1 inhibitor group and the conventional chemotherapy group has bone marrow invasion There was no significant difference in clinical characteristics such as whether the copy number of EBV-DNA in peripheral blood plasma increased(P>0.05);2.At of the end of the follow-up,the median follow-up time of 36 patients was15(6-56)months,the median follow-up time of PD-1 inhibitor group was 12(7-19)months,and the median follow-up time of conventional chemotherapy group The duration is 22(6-56)months.The PFS rate and OS rate in the PD-1 inhibitor group were 100%(9/9),and the PFS rate and OS rate in the conventional chemotherapy group were 18.5%(5/27)and 22.2%(6/27),respectively.PFS in the two groups The rate and OS rate are both statistically different(P<0.05);3.The CR rate after 4 cycles of treatment in the PD-1 inhibitor group was 77.8%(7/9)and the ORR rate was 100%(9/9),respectively.The CR rate and ORR rate of patients in the conventional chemotherapy group after 4 cycles of treatment were respectively 49.1%(13/27)and 70.3%(19/27),there was no statistical difference in CR rate and ORR rate between the two groups(P>0.05);4.The positive rates of EBV-DNA copy number before treatment in PD-1inhibitor group and conventional chemotherapy group were 88.9%(8/9)and 77.8%(21/27),respectively,and the negative conversion rate was 87.5%(7/8)and 81.0%(17/21),there was no significant difference in the effect of EBV-DNA copy number conversion rate of PD-1 inhibitor group and conventional chemotherapy group on the CR rate and ORR rate of patients(p>0.05);5.Patients in the PD-1 inhibitor group did not see significantly increased liver and kidney damage,and no immune-related adverse events;6.Multivariate Cox regression analysis of 36 patients showed that EGOG score and 4-cycle remission were independent factors influencing the OS rate in newly treated patients with stage Ⅲ/Ⅳ extranodal NK/T cell lymphoma.Conclusion1.For newly treated ENKTL patients with stage Ⅲ/Ⅳ,PD-1 inhibitor combined with P-Gemox-Dex regimen can improve the OS rate and PFS rate of patients;2.There is no difference in the effect of EBV-DNA copy number conversion rate on CR rate and ORR rate of PD-1 inhibitor group and conventional chemotherapy group;3.PD-1 inhibitor combined with P-Gemox-Dex regimen in the treatment of newly treated patients with stage Ⅲ/Ⅳ ENKTL has mild adverse reactions and good tolerability;4.EGOG score ≥ 2 points and unremission of 4-cycle assessment are independent factors affecting the OS rate of newly treated patients with stage Ⅲ/Ⅳ extranodal NK/T cell lymphoma.