Annals of Hematology

, Volume 94, Issue 3, pp 437–444 | Cite as

Ifosfamide, methotrexate, etoposide, and prednisolone (IMEP) plus l-asparaginase as a first-line therapy improves outcomes in stage III/IV NK/T cell-lymphoma, nasal type (NTCL)

  • Miso Kim
  • Tae Min Kim
  • Ki Hwan Kim
  • Bhumsuk Keam
  • Se-Hoon Lee
  • Dong-Wan Kim
  • Jong Seok Lee
  • Yoon Kyung Jeon
  • Chul Woo Kim
  • Dae Seog Heo
Original Article


The prognosis of patients with stage III/IV NK/T-cell lymphoma (NTCL) is extremely poor. Although l-asparaginase (l-asp) is effective for NTCL, its significance has not been clearly demonstrated. In addition, there are few studies comparing treatment outcomes in stage III/IV NTCL. This study evaluated the efficacy of l-asp-based chemotherapy and prognostic factors in stage III/IV NTCL. Seventy patients with newly diagnosed stage III/IV NTCL were enrolled between January 2000 and February 2013. Patients received ifosfamide, etoposide, methotrexate, and prednisolone (IMEP) plus l-asp (N = 22) or combination chemotherapy without l-asp (N = 48) as a first-line treatment. Clinical prognostic factors, treatment outcomes, and prognostic scores were compared between the groups. After a median follow-up period of 12.8 months (range, 1.1–186.6 months), median overall survival (OS) and progression-free survival (PFS) were 11.3 and 5.6 months, respectively. Treatment outcomes were superior in patients treated with IMEP plus l-asp compared to those treated with chemotherapy without l-asp (overall response rate, 90.0 vs. 34.8 %, P < 0.001; complete remission rate, 65.0 vs. 21.7 %, P = 0.001). The OS and PFS were significantly higher for the IMEP plus l-asp group compared with the chemotherapy without l-asp group. In a multivariate analysis, the use of chemotherapy without l-asp was an independent predictor of reduced OS (hazards ratio (HR) = 2.18, 95 % confidence interval (CI) 1.08–4.40; P = 0.030) and PFS (HR = 2.29, 95 % CI 1.22–4.29; P = 0.010). IMEP plus l-asp is active against stage III/IV NTCL, and it is an independent predictor of improved survival.


Ifosfamide Methotrexate Etoposide Prednisolone l-asparaginase Extranodal NK/T-cell lymphoma, nasal type 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Miso Kim
    • 1
  • Tae Min Kim
    • 1
  • Ki Hwan Kim
    • 2
  • Bhumsuk Keam
    • 1
  • Se-Hoon Lee
    • 1
  • Dong-Wan Kim
    • 1
  • Jong Seok Lee
    • 3
  • Yoon Kyung Jeon
    • 4
  • Chul Woo Kim
    • 4
  • Dae Seog Heo
    • 1
  1. 1.Department of Internal Medicine, Seoul National University Hospital, Cancer Research InstituteSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Internal MedicineSeoul National University Boramae Medical CenterSeoulSouth Korea
  3. 3.Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of PathologySeoul National University HospitalSeoulSouth Korea

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