Zuo Xinyu, Qian Wensi, Wu Min, Xie Yanhui, Ma Jiexian
Department of Hematology, Huadong Hospital, Fudan University, Shanghai, China.
Cancer Med. 2024 Dec;13(23):e70476. doi: 10.1002/cam4.70476.
Peripheral T-cell lymphomas (PTCL) frequently result in relapsed or refractory diseases. Upfront autologous hematopoietic stem cell transplantation (ASCT) using the BEAM (carmustine, etoposide, cytarabine, and melphalan) regimen is recommended. However, relapses are common in PTCL, highlighting a critical need for improved survival outcomes in these patients.
Anthracycline drugs are essential in treating PTCL. We compared the efficacy and tolerability of a high-dose mitoxantrone-based conditioning regimen [mitoxantrone, cyclophosphamide, and etoposide (MCE)] to the BEAM regimen in upfront ASCT for newly diagnosed PTCL patients who achieved complete or partial remission after induction therapy.
A retrospective study was conducted to analyze the treatment response, progression-free survival (PFS), overall survival (OS), hematologic engraftment time, and adverse events of 64 patients between two regimens, who achieved complete or partial remission after induction chemotherapy. Twenty-eight patients received the MCE regimen, while 36 patients were treated with the BEAM regimen.
There were no significant differences in clinical characteristics or the incidence of adverse events between the two groups. However, the median OS significantly favored the MCE group at 102.4 (95% CI, 87.0-117.8) months compared to 62.6 (95% CI, 50.8-74.5) months in the BEAM group (p = 0.023). Similarly, the median PFS was longer in the MCE group at 87.8 (95% CI, 65.8-109.8) months versus 42.5 (95% CI, 30.0-55.0) months in the BEAM group (p = 0.031).
ASCT with the mitoxantrone-based conditioning regimen is tolerable and appears to significantly improve the prognosis of PTCL patients, offering a promising alternative to the current standard of care.
外周T细胞淋巴瘤（PTCL）常导致疾病复发或难治。推荐使用BEAM（卡莫司汀、依托泊苷、阿糖胞苷和美法仑）方案进行一线自体造血干细胞移植（ASCT）。然而，PTCL复发很常见，凸显了改善这些患者生存结局的迫切需求。
蒽环类药物对PTCL治疗至关重要。我们比较了高剂量米托蒽醌预处理方案[米托蒽醌、环磷酰胺和依托泊苷（MCE）]与BEAM方案在一线ASCT中对诱导治疗后达到完全或部分缓解的新诊断PTCL患者的疗效和耐受性。
进行一项回顾性研究，分析64例诱导化疗后达到完全或部分缓解的患者在两种方案下的治疗反应、无进展生存期（PFS）、总生存期（OS）、血液学植入时间和不良事件。28例患者接受MCE方案，36例患者接受BEAM方案。
两组患者的临床特征或不良事件发生率无显著差异。然而，MCE组的中位OS显著优于BEAM组，分别为102.4（95%CI，87.0-117.8）个月和62.6（95%CI，50.8-74.5）个月（p = 0.023）。同样，MCE组的中位PFS更长，为87.8（95%CI，65.8-109.8）个月，而BEAM组为42.5（95%CI，30.0-55.0）个月（p = 0.031）。
基于米托蒽醌的预处理方案进行ASCT耐受性良好，似乎能显著改善PTCL患者的预后，为当前的标准治疗提供了有前景的替代方案。
