Norasetthada Lalita, Tantiworawit Adisak, Rattanathammethee Thanawat, Chai-Adisaksopha Chatree, Chaipoh Thanapat, Rattarittamrong Ekarat
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Hematol. 2018 Dec;7(4):131-139. doi: 10.14740/jh459w. Epub 2018 Nov 22.
Salvage chemotherapy is the mainstay for the treatment of relapsed/refractory peripheral T-cell lymphomas (R/R PTCLs). ESHAP regimen, consisting of etoposide, methylprednisolone, high-dose Ara-C, and cisplatin is considered one of the well-accepted regimens for R/R lymphoma. Though, the evidence of long-term efficacy of ESHAP on R/R PTCLs is limited. This study aims to determine the efficacy and safety of ESHAP as a first salvage regimen, not followed by autologous stem cell transplantation (ASCT), in R/R PTCLs.
Patients with PTCLs, who progressed after one prior therapy and received ESHAP as a salvage treatment without subsequent ASCT, were recruited from the prospective observational study in the patients with lymphoma.
From January 2005 to April 2015, 33 patients with R/R PTCLs received ESHAP as first salvage regimen at Chiang Mai University Hospital. The overall response rate was 46% (complete remission (CR) 39%). The median duration of response was 18 months. Median second progression-free survival (PFS) and overall survival (OS) were 8.0 and 11.0 months, respectively. Patients having late relapse had more favorable OS than those having early relapsed or refractory disease with a median OS of 21, 17 and 3 months, respectively (P = 0.001). Patients achieving CR after ESHAP had significantly better median OS (39, 7 and 5 months, P < 0.0001) and second PFS (33, 2 and 2 months, P < 0.0001) than those achieving PR or having progressive disease. Grade 3-4 neutropenia (45.5%) and thrombocytopenia (33.4%) were common but manageable.
ESHAP offers a long-term survival in some transplant ineligible patients with PTCLs who were chemosensitive with late relapse after front-line therapy. These results require further investigation in a prospective study.
挽救性化疗是复发/难治性外周T细胞淋巴瘤（R/R PTCLs）治疗的主要手段。由依托泊苷、甲泼尼龙、大剂量阿糖胞苷和顺铂组成的ESHAP方案被认为是R/R淋巴瘤广泛接受的方案之一。然而，ESHAP方案对R/R PTCLs长期疗效的证据有限。本研究旨在确定ESHAP作为一线挽救方案（不进行自体干细胞移植（ASCT））治疗R/R PTCLs的疗效和安全性。
从淋巴瘤患者前瞻性观察研究中招募PTCLs患者，这些患者在接受一次先前治疗后病情进展，并接受ESHAP作为挽救治疗且未进行后续ASCT。
2005年1月至2015年4月，33例R/R PTCLs患者在清迈大学医院接受ESHAP作为一线挽救方案。总缓解率为46%（完全缓解（CR）率为39%）。中位缓解持续时间为18个月。中位第二次无进展生存期（PFS）和总生存期（OS）分别为8.0个月和11.0个月。晚期复发患者的OS比早期复发或难治性疾病患者更有利，中位OS分别为21个月、17个月和3个月（P = 0.001）。ESHAP治疗后达到CR的患者的中位OS（39个月、7个月和5个月，P < 0.0001）和第二次PFS（33个月、2个月和2个月，P < 0.0001）明显优于达到部分缓解（PR）或疾病进展的患者。3-4级中性粒细胞减少（45.5%）和血小板减少（33.4%）常见但可控。
ESHAP为一些不符合移植条件、对一线治疗后晚期复发有化疗敏感性的PTCLs患者提供了长期生存。这些结果需要在前瞻性研究中进一步调查。
