Analysis Of The Clinical Characteristics,Therapeutic Efficacy And Prognostic Factors Of 47 Peripheral T Cell Lymphoma

Objective To investigate the clinical characteristics,therapeutic efficacy and prognostic factors of peripheral T cell lymphoma(PTCL),at the same time,to evaluate the effects of chidamide in the treatment of peripheral T-cell lymphoma and to explore new treatment combinations.Clinical experience presented in this study may serve as reference for future large cohort studies.Methods A retrospective analysis was performed on 39 PTCL patients with complete clinical data who were admitted to the afiliated hangzhou first people’s hospital of zhejiang university school of medicine from November 2009 to December 2020.The information collected in this study included general information(age,gender,Ann Arbor stage,B symptoms,IPI score,pathological type,bone marrow invoIvement,other involved sites),laboratory examination(white blood cell count,hemoglobin count,platelet count,LDH,β2-microglobulin,ki-67 percentage),treatment(chemotherapy therapy,whether or not to use Chidamide and hematopoietic stem cell transplantation,etc),short-term efficacy and long-term survival(progression free survival,overall survival,status,etc).Data analysis was performed using SPSS 22.0 statistical software.P<0.05 was statistically significant.Results 1.Among the 47 PTCL patients,the ratio of male to female was about 2.6:1 and the median age was 61.14 patients(29.7%)are extranodal NK/T-cell lymphoma,nasal type(ENKTL).13 patients(27.7%)are peripheral T cell lymphoma not otherwise specified(PTCL-NOS).12 patients(25.5%)are angioimmunoblastic T-cell lymphoma(AITL).4 patients(8.5%)are anaplastic large cell lymphoma(ALCL).The others included 2 patients(4.3%)of hepatosplenic T-Cell Lymphoma,1 patient(2.1%)of cutaneous T-cell lymphoma(CTCL)and 1 patient(2.1%)of nodal peripheral T-cell lymphoma with TFH phenotype.10(21.3%)had leukopenia,26(55.3%)had hemoglobinopenia and 17(36.2%)had thrombocytopenia.LDH was increased 26 cases(55.32%),β2-MG was increased 39 cases(82.98%)and Ki-67 was increased(>25%)34(72.34%).There were 7 patients(14.9%)with intranode involvement alone,12 patients(25.5%)with extranode involvement alone,and 28 patients(59.6%)with intranode and extranode involvement simultaneously.2.A total of 47 patients,11 patients achieved complete remission(CR)and 14 patients achieved partial remission(PR).The initial therapeutic objective response rate(ORR)was 53.2%and the total disease control rate(DCR)was 72.3%.The ORR and DCR of ENKCL respectively was 78.6%and 85.7%.The ORR and DCR of PTCL-NOS respectively was 53.8%and 76.9%.The ORR and DCR of AITL respectively was 33.3%and 58.3%.The chi-square test showed that there was no significant correlation between ORR and different pathological types(X2=5.43,P=0.066).3.Among the 47 PTCL patients,3 patients were untreated and 2 patients were treated with first-line chidamide monotherapy.CHOP/CHOP-like regimen ORR was 48.0%in 25 patients.GELOX regimen ORR was 83.3%in 6 patients.GEM OX regimen ORR was 100%in 3 patients.GDP regimen ORR was 0.0%in 4 patients.2 patients received SMILE regimen;1 patient received Hyper-CVAD regimen;1 patient received DICE regimen.According to the chi-square test,there was statistical difference in ORR between different treatment regimen.In addition,a total of 9 patients received hematopoietic stem cell transplantation including 6 cases of CR and 1 case of PR.4.A total of 24 PTCLs treated with Chidamide and the ORR was 45.8%.5 patients received chidamide monotherapy and ORR was 60.0%.The ORR was 47.4%in 19 patients with PTCL treated with Chidamide combined with chemotherapy.The mean OS was 29.5(2-170)months.To the date of follow-up,15 patients died.There was no statistically significant difference in OS between the 24 patients treated with chidamide and the 23 patients treated without chidamide(P=0.591).5.Up to study termination time,17 patients died and 30 patients survived.The median progression free survival was 210d(13-5194d)and the median overall survival was 31 months(1-170months).According to K-M survival curve analysis,the 1-year PFS and OS were about 67.7%and 74.5%,respectively.The 5-year PFS and OS were about 54.4%and 60.7%,respectively.6.Kaplan-meier univariate analysis shows that abnormal blood indicators(leukopenia,anemia,thrombocytopenia),increased β2-MG,bone marrow involvement,pathological type,remission after first-line treatment were associated with survival rates(p<0.05).Multivariate analysis showed that anemia,IPI score,pathological type,remission after first-line treatment were independent prognostic factors for PTCLs(p<0.05).Conclusion 1.Peripheral T cell lymphomas are a remarkably heterogeneous set of diseases.The most common subtypes in this study are the extranodal NK/T cell lymphoma,nasal type(ENKTL),peripheral T cell lymphoma not otherwise(PTCL-NOS)and angioimmunoblastic T cell lymphoma(AITL).Males have a higher risk for many PTCL subtypes and the median age for PTCLs is older than 60 years.2.Multiagent chemotherapy with a CHOP/CHOP-like regimen is the current standard of care in the frontline setting,but outcomes for PTCL patients generally remain poor.The use of an gemcitabin-containing regimen was not associated with an improved outcome in PTCLs and stem cell transplantation may lead to better outcomes.3.Chidamide combined with chemotherapy have shown good tolerance and therapeutic effects in the treatment of relapsed/refractory peripheral T-cell lymphoma.And chidamide combined with azacitidine may be a new treatment choice for refractory/relapsed PTCL patients which is poised to make the most enduring impact on survival outcome.4.Multivariate analysis showed that anemia,IPI score,pathological type,remission after first-line treatment were independent prognostic factors for PTCLs.