Guo Wei, Wang Xingtong, Li Jia, Yin Xianying, Zhao Yangzhi, Tang Yang, Wang Anna, Bai Ou
Department of Hematology, The First Hospital of Jilin University, Changchun, China.
Front Oncol. 2022 Jun 7;12:875469. doi: 10.3389/fonc.2022.875469. eCollection 2022.
To assess the potential benefit of chidamide maintenance therapy after induction treatment in peripheral T-cell lymphoma (PTCL).
The clinical data of 48 transplantation-ineligible patients with different PTCL subtypes who received continuous chidamide treatment after first-line therapy were collected. Progression-free survival (PFS), overall survival (OS), and safety were analyzed.
In total, 68.8% of patients were male (33/48), the median age was 59.5 years (2280). The pathological subtypes were angioimmunoblastic T-cell lymphoma (AITL, 43.8%), anaplastic large cell lymphoma (ALCL, 16.6%), PTCL-not otherwise specified (NOS, 25%), NK/T-cell lymphoma (NKT, 14.6%). 35.4% (7/48) patients had intermediate or high risk (IPI=35). 20 patients (41.7%) received chidamide as a maintenance treatment after achieving a complete response (CR). 57.1% (16/28) exhibited a better response after chidamide (9 cases partial response [PR] to CR, 7 from stable disease [SD] to PR). The CR and overall response rate (ORR) were 60.4% and 93.8%, respectively. In addition, 21/21 AITL, 10/12 PTCL-NOS, and 8/8 ALCL, 6/7 NK/T exhibited CR/PR as the best response during the follow-up period. Meanwhile, the CR and ORR did not differ by age (<60 ≥60: 50.0% 70.8%, P = 0.091; and 91.7% 95.8%, P = 0.551). The median follow-up period was 12.8 months (3.0-66.6), 14 patients developed PD (29.2%), 10 of them died of lymphoma (20.8%). Totally, the 40 cases achieved CR/PR from 1st line regimen got better PFS as well as OS than the rest 8 cases (the 1-year PFS was 80.8% 46.9% and the 2-year PFS was 71.9% 46.9%, P=0.012. the 1-year OS was 89.9% 72.6% and the 2-year OS was 85.9% 48.6%, P=0.032). No patients discontinued treatment because of adverse events. The most common toxicities were neutropenia (75.0%), anemia (79.2%), thrombocytopenia (58.3%), and anorexia (45.8%), and fatigue (43.8%).
Chidamide maintenance therapy led to improvements of PFS and OS with a manageable safety profile in patients with PTCL. Further randomized studies are required to examine the role of chidamide maintenance therapy in PTCL.
评估西达本胺维持治疗对外周T细胞淋巴瘤（PTCL）诱导治疗后的潜在益处。
收集48例一线治疗后接受持续西达本胺治疗的不符合移植条件的不同PTCL亚型患者的临床资料。分析无进展生存期（PFS）、总生存期（OS）和安全性。
患者中男性占68.8%（33/48），中位年龄为59.5岁（2280岁）。病理亚型为血管免疫母细胞性T细胞淋巴瘤（AITL，43.8%）、间变性大细胞淋巴瘤（ALCL，16.6%）、未另行特指的PTCL（NOS，25%）、NK/T细胞淋巴瘤（NKT，14.6%）。35.4%（7/48）的患者具有中高危（国际预后指数IPI=35）。20例患者（41.7%）在达到完全缓解（CR）后接受西达本胺作为维持治疗。57.1%（16/28）的患者在接受西达本胺治疗后有更好的反应（9例部分缓解[PR]转为CR，7例病情稳定[SD]转为PR）。CR率和总缓解率（ORR）分别为60.4%和93.8%。此外，21/21例AITL、10/12例PTCL-NOS、8/8例ALCL、6/7例NK/T在随访期间最佳反应为CR/PR。同时，CR率和ORR在年龄方面无差异（年龄<60岁与≥60岁：分别为50.0%与70.8%，P = 0.091；91.7%与95.8%，P = 0.551）。中位随访期为12.8个月（3.0~66.6个月），14例患者疾病进展（29.2%），其中10例死于淋巴瘤（20.8%）。总体而言，40例一线方案达到CR/PR的患者的PFS和OS均优于其余8例患者（1年PFS分别为80.8%与46.9%，2年PFS分别为71.9%与46.9%，P = 0.012；1年OS分别为89.9%与72.6%，2年OS分别为85.9%与48.6%，P = 0.032）。无患者因不良事件停药。最常见的毒性反应为中性粒细胞减少（75.0%）、贫血（79.2%）、血小板减少（58.3%）、厌食（45.8%）和疲劳（43.8%）。
西达本胺维持治疗可改善PTCL患者的PFS和OS，且安全性可控。需要进一步的随机研究来探讨西达本胺维持治疗在PTCL中的作用。
