| Objectives: Peripheral T-cell lymphoma(PTCL) is a class of relatively low incidence, highly heterogeneous lymphomas. Current therapies, based on historical CHOP/CHOP-like therapy, have resulted in insufficient outcomes, except ALCL(ALK+), and 5-year OS are only 30%. Hyper-CVAD/MA regimen, designed by the MD Anderson Cancer Centre, has been investigated in treatment of PTCL, with acceptable efficacies and toxicities. Nowdays, anti-angiogenic therapy has lead a new direction in cancer therapy, having achieved remarkable results in many cancers. This study has compared the clinical efficacy and safety of Anti-angiogenesis(endostar) combined with CHOP-like regimen, Hyper-CVAD/MA and CHOP/CHOP-like regimens in therapy of PTCL patients.Then, to explore some new strategies in PTCL therapy.Methods: Primary PTCL patients about 110 cases were retrospectively analyzed, initially treated in Tianjin Cancer Hospital from Oct.2008 to Oct.2014. They were divided into three groups according to first-line chemotherapy:group A(Endostar+CHOP-like) of 26 cases, group B(Hyper-CVAD/MA) of 22 cases and group C(CHOP-like) of 62 cases. After at least 4 circles' treatment, the efficacy and survival were compared. Count data were compared using Pearson?2 test; measurement data using t-test. Survival were estimated by Kaplan-Meier and log-rank test; Cox hazard model multivariate analysis of prognosis.Results:1. Clinical characteristics: The median age were 55, 51 and 55, respectively; percentages of male were 53.8%, 72.7% and 61.3%;ECOG PS?2 in 18.8%, 9.1% and 12.9%; the main histologic types, PTCL- NOS: 50.0%, 50.0% and 48.4%, AITL: 26.9%, 9.1% and 11.3%, ALCL(ALK-): 15.4%, 27.3% and 22.6%. Useing Ann Arbor stage, percentages of III-IV were 80.8% 77.3% and 69.4%; IPI score of 3-5 were 57.7%,40.9% and 41.9%; median chemotherapy were 4,6 and 6 cycles. The clinic features were not significant differences(P>0.05).2. The ORR of three groups were 76.9%, 81.8% and 56.5%. The group B was higherthan the other groups(P=0.041). The group A was also higher than group C, but no statistical difference(P=0.07).Three groups of relapse rates were similar in 69.2%, 63.6% and 85.5%.3. According to the stage, the ORR of three schemes in early stage(I/II) patients were no significant difference(P=0.331). In advanced stage, group B was significantly higher than other groups(82.4%vs71.4% vs51.2%, P=0.045).4. Whether IPI score of 0-2 or 3-5, the ORR in three schemes showed no significant difference. Moreover, the efficacy of the former two groups were higher than 70%.5. The median PFS were significantly improved by the former two groups(16,17 and 12 months, P=0.022), similarly in the 1,2and 3-year PFS. In contrast with group C, The PFS in group A was prolonged(P<0.05). The OS were similar(P>0.05).6.The incidences of III/IV neutropenia and thrombocytopenia in group B(respectively77.3%,54.5%)were higher than the other groups(P<0.05). The group A had five cases of abnormal electrocardiogram(P=0.032), other toxicities were similar to group C.7. Multivariate analysis showed that ECOG PS and clinical efficacy were independent risk factors of the whole patients.Conclusions:1. The efficacy of Hyper-CVAD/MA was superior to CHOP/CHOP-like regimen. Although with a high incidence of hematologic toxicity. this regimen could be an alternative choices for young high-risk patients.2. Compared to historical therapy, anti-angiogenesis combined with chemotherapy has a similar effect, and prolonged survival. Due to the high efficiency, low toxicity and targeting, Endostar combined with chemotherapy could be recommended into the first-line treatments of PTCL. |
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