-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Peripheral T-cell lymphoma (PTCL) has certain heterogeneity, and the morphology, immunohistochemistry, and molecular characteristics of each subtype are different.
Except for ALK-positive anaplastic large cell lymphoma (ALCL), most PTCL has a poor prognosis.
At present, the CHOP regimen or CHOP combined with etoposide regimen (CHOEP) sequential autologous hematopoietic stem cell transplantation (AutoSCT) is the first choice for young PTCL patients.
A retrospective study showed that the 3-year event-free survival (EFS) rate of young PTCL patients receiving CHOP regimen was 48%, and the 3-year EFS rate of receiving CHOEP regimen was 61%.
The Swedish research data showed that the progression-free survival (PFS) rate and overall survival (OS) rate of PTCL patients who received transplantation after CHOP or CHOEP regimens were 44% and 51%, respectively.
However, the current phase III study comparing AutoSCT and related alternative therapies is currently underway.
It is still unclear which patients can benefit from AutoSCT after induction chemotherapy, and whether all PTCL patients who achieve disease remission after induction chemotherapy need to receive AutoSCT.
In view of the fact that allogeneic hematopoietic stem cell transplantation (AlloSCT) has achieved better results in relapsed and refractory PTCL, and nearly 50% of patients have long-term survival, a phase III study conducted by 44 centers in France and Germany compared AutoSCT and AlloSCT in PTCL The main results of the study are summarized below for the reference of the general readers.
The key point: conventional therapy sequential AutoSCT is still the main treatment option for patients with PTCL.
Patients with relapsed and refractory PTCL should receive AlloSCT treatment.
Research methods The study included patients with PTCL aged 18-60 years, untreated, and poor prognosis (stage II-IV or aaIPI>0), and were randomly assigned to receive four 14-day cycles of CHOEP at a 1:1 ratio.
, 1 course of DHAP treatment, followed by AutoSCT or AlloSCT.
The primary endpoint of the study is EFS, and secondary endpoints include complete remission (CR) rate, disease progression rate, recurrence rate, proportion of patients receiving transplantation, incidence of acute and chronic graft-versus-host disease (GVHD) after AlloSCT, and treatment-related deaths Rate, PFS, OS, security.
Results of the study: A total of 104 patients were included in the study from March 2011 to July 2014.
One patient did not receive any treatment, and 103 patients were included in the intention-to-treat analysis.
54 patients were assigned to receive AutoSCT, and 49 patients were assigned to receive AlloSCT.
The baseline characteristics of the two groups of patients were balanced and there was no significant difference.
In the study, 41 (40%) patients had unspecified PTCL (PTCL-NOS), 35 (34%) patients had angioimmunoblastic T-cell lymphoma (AITL), and 15 (15%) patients There were ALK-negative ALCL, 10 patients (10%) had other subtypes of PTCL, and the pathological type of 2 patients could not be determined.
In the AutoSCT group, 34/54 (63%) patients received transplantation.
The remaining 20 patients were due to early disease progression (15 cases), diagnosis changed to non-PTCL (3 cases), adverse reactions (1 case), and withdrawal from the study ( 1 case) did not receive transplantation.
In the AlloSCT group, 26/49 patients (53%) received transplantation, 15 patients did not complete induction chemotherapy due to early disease progression (14 patients), diagnosis changed to non-PTCL (1 patient), and 8 patients did not complete induction chemotherapy.
The donor was found (7 cases), and the Data Security and Monitoring Committee decided (1 case) to accept AutoSCT instead.
In the end, 41 patients received AutoSCT and 26 patients received AlloSCT.
The median time from induction chemotherapy to transplantation was 107 days in the AutoSCT group and 119 days in the AlloSCT group.
There was a significant difference between the two groups (P=0.
011).
Efficacy 21 (39%) patients in the AutoSCT group and 25 (51%) patients in the AlloSCT group achieved CR/uncertain complete remission (CRu) after all treatments were completed; 9 (17%) patients in the AutoSCT group and Four patients (8%) in the AlloSCT group achieved partial remission (PR); two patients in the AutoSCT group had stable disease (SD).
Nine patients in the AutoSCT group and 4 patients in the AlloSCT group relapsed after reaching CR, CRu, and PR.
One patient in the AutoSCT group and 8 patients in the AlloSCT group died after reaching CR, CRu, and PR.
In the study, 18 patients (33%) in the AutoSCT group and 21 (43%) patients in the AlloSCT group died.
Thirteen patients (72%) in the AutoSCT group and 11 (52%) patients in the AlloSCT group died of disease progression or recurrence; the deaths of 4 patients in the AutoSCT group and 2 patients in the AlloSCT group were related to salvage treatment; 8 patients The death of AlloSCT patients was related to the study treatment; another patient in the AutoSCT group died of secondary tumors.
At a median follow-up of 42 months (range: 0.
2-74 months), the 3-year EFS rate, PFS rate, and OS rate of the AutoSCT group were 38% (95%CI: 25%-52%) and 39% ( 95%CI: 26%-52%), 70% (95%CI: 57%-82%); the 3-year EFS rate, PFS rate, and OS rate of patients in the AlloSCT group were 43% (95%CI: 29%) -57%), 43% (95%CI: 29%-57%), 57% (95%CI: 43%-71%).
There was no significant difference in EFS, PFS, OS between the two groups.
Since only 67 (65%) patients in the study received treatment as planned, the study conducted a subgroup analysis of patients who actually received AutoSCT and AlloSCT.
The 3-year EFS rate of 41 patients who actually received AutoSCT was 57% (95%CI: 42%-73%), and the 3-year EFS rate of 26 patients who actually received AlloSCT was 65% (95%CI: 47%- 84%); the 3-year PFS rate of patients who actually received AutoSCT was 57% (95%CI: 42%-73%), and the 3-year PFS rate of patients who actually received AlloSCT was 65% (95%CI: 47%- 84%); the 3-year OS rate of patients who actually received AutoSCT was 81% (95%CI: 68%-93%), and the 3-year OS rate of patients who actually received AlloSCT was 65% (95%CI: 47%- 84%).
There was no significant difference in EFS, PFS, OS between the two groups.
At a median follow-up of 42 months, 21 patients who achieved CR, CRu, and PR after AlloSCT had no recurrence, while 13 (36%) of 36 patients who achieved CR, CRu, and PR after AutoSCT had recurrence.
The 1-year cumulative recurrence rate of patients who achieved CR, CRu, and PR after AutoSCT was 17% (95%CI: 4%-29%), and the 3-year cumulative recurrence rate was 40% (95%CI: 22%-58%) ); The 1-year cumulative recurrence rate and 3-year cumulative recurrence rate of patients who reached CR, CRu, and PR after AlloSCT were 0%.
In the safety study, there was no significant difference in the incidence and severity of adverse events between the two groups of patients after receiving the CHOEP regimen and the DHAP regimen.
Of the 26 patients who received AlloSCT, 19 patients (73%) developed GVHD, of which 7 patients had GVHD> Grade 2 and 2 patients died.
Eight patients developed chronic GVHD, and one patient died of chronic GVHD and related complications.
There were 3 cases of secondary tumors (3%) in the study, including 1 case of aggressive B-cell lymphoma after AlloSCT, and 2 cases of solid tumor after AutoSCT.
Research conclusions For young patients with PTCL, sequential AutoSCT after standard chemotherapy is still the preferred treatment option.
AlloSCT is the first choice for patients with relapsed and refractory PTCL, and patients who fail AutoSCT can also achieve long-term survival through AlloSCT.
References: Norbert Schmitz, Lorenz Truemper, Krimo Bouabdallah, Marita Ziepert, et al.
A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL.
Blood (2021) 137 ( 19): 2646–2656.
; https://doi.
org/10.
1182/blood.
2020008825 stamp "read the original text", we make progress together
Except for ALK-positive anaplastic large cell lymphoma (ALCL), most PTCL has a poor prognosis.
At present, the CHOP regimen or CHOP combined with etoposide regimen (CHOEP) sequential autologous hematopoietic stem cell transplantation (AutoSCT) is the first choice for young PTCL patients.
A retrospective study showed that the 3-year event-free survival (EFS) rate of young PTCL patients receiving CHOP regimen was 48%, and the 3-year EFS rate of receiving CHOEP regimen was 61%.
The Swedish research data showed that the progression-free survival (PFS) rate and overall survival (OS) rate of PTCL patients who received transplantation after CHOP or CHOEP regimens were 44% and 51%, respectively.
However, the current phase III study comparing AutoSCT and related alternative therapies is currently underway.
It is still unclear which patients can benefit from AutoSCT after induction chemotherapy, and whether all PTCL patients who achieve disease remission after induction chemotherapy need to receive AutoSCT.
In view of the fact that allogeneic hematopoietic stem cell transplantation (AlloSCT) has achieved better results in relapsed and refractory PTCL, and nearly 50% of patients have long-term survival, a phase III study conducted by 44 centers in France and Germany compared AutoSCT and AlloSCT in PTCL The main results of the study are summarized below for the reference of the general readers.
The key point: conventional therapy sequential AutoSCT is still the main treatment option for patients with PTCL.
Patients with relapsed and refractory PTCL should receive AlloSCT treatment.
Research methods The study included patients with PTCL aged 18-60 years, untreated, and poor prognosis (stage II-IV or aaIPI>0), and were randomly assigned to receive four 14-day cycles of CHOEP at a 1:1 ratio.
, 1 course of DHAP treatment, followed by AutoSCT or AlloSCT.
The primary endpoint of the study is EFS, and secondary endpoints include complete remission (CR) rate, disease progression rate, recurrence rate, proportion of patients receiving transplantation, incidence of acute and chronic graft-versus-host disease (GVHD) after AlloSCT, and treatment-related deaths Rate, PFS, OS, security.
Results of the study: A total of 104 patients were included in the study from March 2011 to July 2014.
One patient did not receive any treatment, and 103 patients were included in the intention-to-treat analysis.
54 patients were assigned to receive AutoSCT, and 49 patients were assigned to receive AlloSCT.
The baseline characteristics of the two groups of patients were balanced and there was no significant difference.
In the study, 41 (40%) patients had unspecified PTCL (PTCL-NOS), 35 (34%) patients had angioimmunoblastic T-cell lymphoma (AITL), and 15 (15%) patients There were ALK-negative ALCL, 10 patients (10%) had other subtypes of PTCL, and the pathological type of 2 patients could not be determined.
In the AutoSCT group, 34/54 (63%) patients received transplantation.
The remaining 20 patients were due to early disease progression (15 cases), diagnosis changed to non-PTCL (3 cases), adverse reactions (1 case), and withdrawal from the study ( 1 case) did not receive transplantation.
In the AlloSCT group, 26/49 patients (53%) received transplantation, 15 patients did not complete induction chemotherapy due to early disease progression (14 patients), diagnosis changed to non-PTCL (1 patient), and 8 patients did not complete induction chemotherapy.
The donor was found (7 cases), and the Data Security and Monitoring Committee decided (1 case) to accept AutoSCT instead.
In the end, 41 patients received AutoSCT and 26 patients received AlloSCT.
The median time from induction chemotherapy to transplantation was 107 days in the AutoSCT group and 119 days in the AlloSCT group.
There was a significant difference between the two groups (P=0.
011).
Efficacy 21 (39%) patients in the AutoSCT group and 25 (51%) patients in the AlloSCT group achieved CR/uncertain complete remission (CRu) after all treatments were completed; 9 (17%) patients in the AutoSCT group and Four patients (8%) in the AlloSCT group achieved partial remission (PR); two patients in the AutoSCT group had stable disease (SD).
Nine patients in the AutoSCT group and 4 patients in the AlloSCT group relapsed after reaching CR, CRu, and PR.
One patient in the AutoSCT group and 8 patients in the AlloSCT group died after reaching CR, CRu, and PR.
In the study, 18 patients (33%) in the AutoSCT group and 21 (43%) patients in the AlloSCT group died.
Thirteen patients (72%) in the AutoSCT group and 11 (52%) patients in the AlloSCT group died of disease progression or recurrence; the deaths of 4 patients in the AutoSCT group and 2 patients in the AlloSCT group were related to salvage treatment; 8 patients The death of AlloSCT patients was related to the study treatment; another patient in the AutoSCT group died of secondary tumors.
At a median follow-up of 42 months (range: 0.
2-74 months), the 3-year EFS rate, PFS rate, and OS rate of the AutoSCT group were 38% (95%CI: 25%-52%) and 39% ( 95%CI: 26%-52%), 70% (95%CI: 57%-82%); the 3-year EFS rate, PFS rate, and OS rate of patients in the AlloSCT group were 43% (95%CI: 29%) -57%), 43% (95%CI: 29%-57%), 57% (95%CI: 43%-71%).
There was no significant difference in EFS, PFS, OS between the two groups.
Since only 67 (65%) patients in the study received treatment as planned, the study conducted a subgroup analysis of patients who actually received AutoSCT and AlloSCT.
The 3-year EFS rate of 41 patients who actually received AutoSCT was 57% (95%CI: 42%-73%), and the 3-year EFS rate of 26 patients who actually received AlloSCT was 65% (95%CI: 47%- 84%); the 3-year PFS rate of patients who actually received AutoSCT was 57% (95%CI: 42%-73%), and the 3-year PFS rate of patients who actually received AlloSCT was 65% (95%CI: 47%- 84%); the 3-year OS rate of patients who actually received AutoSCT was 81% (95%CI: 68%-93%), and the 3-year OS rate of patients who actually received AlloSCT was 65% (95%CI: 47%- 84%).
There was no significant difference in EFS, PFS, OS between the two groups.
At a median follow-up of 42 months, 21 patients who achieved CR, CRu, and PR after AlloSCT had no recurrence, while 13 (36%) of 36 patients who achieved CR, CRu, and PR after AutoSCT had recurrence.
The 1-year cumulative recurrence rate of patients who achieved CR, CRu, and PR after AutoSCT was 17% (95%CI: 4%-29%), and the 3-year cumulative recurrence rate was 40% (95%CI: 22%-58%) ); The 1-year cumulative recurrence rate and 3-year cumulative recurrence rate of patients who reached CR, CRu, and PR after AlloSCT were 0%.
In the safety study, there was no significant difference in the incidence and severity of adverse events between the two groups of patients after receiving the CHOEP regimen and the DHAP regimen.
Of the 26 patients who received AlloSCT, 19 patients (73%) developed GVHD, of which 7 patients had GVHD> Grade 2 and 2 patients died.
Eight patients developed chronic GVHD, and one patient died of chronic GVHD and related complications.
There were 3 cases of secondary tumors (3%) in the study, including 1 case of aggressive B-cell lymphoma after AlloSCT, and 2 cases of solid tumor after AutoSCT.
Research conclusions For young patients with PTCL, sequential AutoSCT after standard chemotherapy is still the preferred treatment option.
AlloSCT is the first choice for patients with relapsed and refractory PTCL, and patients who fail AutoSCT can also achieve long-term survival through AlloSCT.
References: Norbert Schmitz, Lorenz Truemper, Krimo Bouabdallah, Marita Ziepert, et al.
A randomized phase 3 trial of autologous vs allogeneic transplantation as part of first-line therapy in poor-risk peripheral T-NHL.
Blood (2021) 137 ( 19): 2646–2656.
; https://doi.
org/10.
1182/blood.
2020008825 stamp "read the original text", we make progress together
