Outcomes and Prognostic Factors of the Alternative Regimens for Angioimmunoblastic T Cell Lymphoma: A Retrospective Study
Authors: Yan Jiaqin , Wang Bingjie , Wei Yankui , Zhang Shasha , Zhang Lei , Li Ling , Li Xin , Fu Xiaorui , Wang Xinhua , Sun Zhenchang , Zhang Xudong , Zhang Mingzhi 
Published: December 2024

Angioimmunoblastic T cell lymphoma (AITL) is the second common subtype of peripheral T cell lymphoma. Unfortunately, patients diagnosed with AITL typically experience poor outcomes. There is still no clear consensus on the frontline management of AITL. In the current study, we conducted a retrospective analysis of patients from two hospitals in China and reported outcomes for patients who underwent various treatment regimens, taking into account multiple variables such as clinical features, staging, PIT score, and other relevant factors.

We assessed survival outcomes and prognostic factors in 174 patients diagnosed with AITL who received five different regimens across two centers. All patients were pathologically diagnosed by biopsy according to the 2008 World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. All patients in this study underwent bone marrow biopsy. Among them, 58 patients (33.3%) received the CHOP regimen (cyclophosphamide + vincristine + doxorubicin + prednisone), 33 patients (19.0%) received the CHOPE regimen (cyclophosphamide + vincristine + doxorubicin + prednisone + etoposide), 35 patients (20.1%) received the CPET regimen (chidamide + prednisone + etoposide + thalidomide), 28 patients (10.2%) received the GDPT (gemcitabine + cisplatin + prednisone + thalidomide), and 20 patients (7.2%) received the DACEP regimen (Dasatinib + Azacitidine + Cyclophosphamide + Etoposide + Prednisone). Treatment responses were evaluated using imaging examinations (PET-CT or CT) and categorized into four states: complete remission (CR), partial remission (PR), stable disease (SD), and disease progression (PD). The overall response rate (ORR) combines rates of complete response (CR) and partial response (PR). Evaluations were conducted after every two cycles of chemotherapy.

Among all 174 patients, the CR rate and ORR rate were 26.9% and 51.7%, respectively. In the CHOP, CHOPE, CPET, GDPT, and DACEP groups, CR rates were 15.1%, 22.2%, 9.4%, 12.5%, and 39.1%, respectively (p=0.03), with corresponding ORR rates of 38.2%, 30.2%, 44.4%, 50.0%, and 65.2%, respectively (p=0.02). As of May 2024, the median follow-up duration for all patients was 19 months with range from 1 to 103 months. The median overall survival (OS) and progression-free survival (PFS) were 20 months and 12 months, respectively. Among patients with ECOG &lt;2, the 3-year OS rates of the CHOP, CHOPE, CPET, GDPT, and DACEP groups were 49%, 46%, 83%, 71%, and 85%, respectively. The corresponding 3-year PFS rates were 41%, 31%, 75%, 48%, and 82%. The DACEP group demonstrated the highest 3-year OS and PFS rates in this subset, indicating superior survival outcomes compared to other regimens. For patients with ECOG ≥2 group, comparable 3-year PFS and OS rates were observed across the different treatment groups.

Collectively, our study underscores that patients with AITL treated with DACEP regimen exhibited notably higher response rates and prolonged survival time compared to other therapeutic approaches.