Comparison of Efficacy and Safety of Gdpt and CHOP in First-Line Treatment of Peripheral T-Cell Lymphoma

Peripheral T-cell lymphoma (PTCL) is a subtype of non-Hodgkin's lymphoma (NHL), which originates from thymus T cells and is highly heterogeneous and aggressive. In China, the incidence of PTCL is about 25%-30%, higher than 10%-15% in Western countries. It is highly aggressive, prone to relapse, poor prognosis, and difficult to treat.Clinically, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) and CHOP-like regimens, mainly anthracyclines, are the main choices for the treatment of PTCL, but the treatment effect is poor, with an objective remission rate of 60%-70% and a 5-year overall survival rate of 25%-35%.Some patients are prone to relapse and progression or even death after treatment.There are reports of using Hyper CVAD/IVAC (cyclophosphamide, doxorubicin, vincristine, dexamethasone, methotrexate, cytarabine) enhance regimen for treatment, but it dose not improve the prognosis.At present, new chemotherapy regimens are still needed to further improve the efficacy.GDP (gemcitabine, cisplatin, dexamethasone) regimens are commonly used in the second-line treatment of PTCL patients. Thalidomide can inhibit angiogenesis by inhibiting the expression of cytokines such as vascular endothelial growth factor and fibroblast cytokine. Previous studies have confirmed that gemcitabine, thalidomide, and cisplatin have synergistic effects. Therefore, the GDT (gemcitabine, cisplatin, dexamethasone, and thalidomide) regimen can be used as a potential first-line chemotherapy regimen for PTCL.Previous clinical studies have demonstrated the feasibility and safety of the GDT regimen as a first-line treatment for PTCL.The efficacy and safety of the GDT regimen and the CHOP regimen as a first-line treatment for PTCL is compared in this study, and we explore the risk factors affecting the prognosis, providing more clinical data for the first-line treatment of PTCL patients.

Recent efficacy evaluation: As of October 1, 2023, the ORR of the GDT group was 70.2%, and the ORR of the CHOP group was 50.0%. The ORR of the GDT group was significantly better than that of the CHOP group (P<0.001). The CRR of the GDT group was 43.3%, and the CRR of the CHOP group was 21.6%. The CRR of the GDT group was significantly higher than that of the CHOP group (P<0.001). In the GDT group, the CRR of PTCL-NOS, ALK-ALCL, AITL, and PTCL-others were 50.0%, 14.3%, 66.7%, and 40.0%, and the ORR were 80.8%, 46.4%, 86.7%, and 65.0%, respectively. In the CHOP group, the CRR of PTCL-NOS, ALK-ALCL, AITL, and PTCL-others were 18.75%, 22.7%, 27.8%, and 14.3%, and the ORR were 43.75%, 68.2%, 47.2%, and 46.4%, respectively. In the PTCL-NOS and ALK-ALCL groups, the ORR of the GDT group was significantly higher than that of the CHOP group (P=0.013; P<0.001). In the PTCL-NOS subgroup, the PTCL-others subgroup, and the ALK-ALCL group, the CRR in the GDPT group was significantly higher than that in the CHOP group (P=0.014; P=0.043; P=0.002).Long-term efficacy evaluation: In the GDT group, the 4-year PFS rate was 65.7%, and the 4-year OS rate was 65.9%. In the CHOP group, the 4-year PFS rate was 51.4%, and the 4-year OS rate was 53.4%.The PFS and OS in the GDT group were better than those in the CHOP group, with statistically significant differences (P=0.032, P=0.001).In the GDT group, there were significant differences in PFS and OS among the four pathological subtypes (P<0.001, P=0.004).In the CHOP group, there was no significant difference in PFS and OS among the four pathological subtypes (P=0.358, P=0.280). Adverse reactions: In the GDT group, the main adverse reactions were mainly in the hematological system and digestive system. The common adverse reactions in the hematological system were leukopenia (98 cases, 84.2%), neutropenia (62 cases, 59.6%), thrombocytopenia (20 cases, 19.2%) and anemia (15 cases, 14.4%); The common adverse reactions in the digestive system were nausea (52 cases, 50%), loss of appetite (50 cases, 48.1%) and vomiting (40 cases, 38.5%).In the CHOP group, the main adverse reactions were in the hematological system and digestive system. The most common adverse reaction in the hematological system was leukopenia (92 cases, 90.2%), followed by neutropenia (60 cases, 58.8%), thrombocytopenia (27 cases, 26.5%) and anemia (13 cases, 12.7%).