Background: Frontline therapies in Mature T/NK-cell Lymphomas need optimization given the high incidence of primary refractoriness and relapse. In retrospective studies, adding etoposide to CHOP (CHOEP) improved PFS in younger and ALK+ ALCL patients, whereas BVCHP improved PFS and OS over CHOP albeit seemingly in the ALCL subtype. It is unknown how CHOEP and BVCHP compare, and the ECHELON2 trial was underpowered to assess histological specific effects, highlighting critical knowledge gaps to be addressed.
Methods: This retrospective analysis used data from the global PETAL consortium cohort across 6 sites. Patients received frontline CHOP, CHOEP, or BVCHP, irrespective of histologic subtype. Kaplan-Meier methods estimated Overall Survival (OS) and Event Free Survival (EFS), and Cox Proportional Hazards adjusted for age, PIT score, and histology.
Results: 460 patients were included receiving CHOP(266; 58%), CHOEP(134; 29%), or BVCHP(60; 13%). Median (range) age was 58(16-92), 54(20-83), and 64(20-81) in CHOP, CHOEP, and BVCHP, treated patients, respectively. Histologic subtypes included PTCLNOS 113(43%), 48(36%), and 11(18%), AITL 38(14%), 18(13%), and 3(5%), and ALCL in 70(26%), 44(33%), and 40(67%) patients, in CHOP, CHOEP, and BVCHP groups, respectively. BVCHP improved EFS over CHOEP in PTCLNOS (HR 0.39; 95%CI 0.24-0.66; p<0.001), AITL (HR 0.37; 95%CI 0.22-0.63; p<0.001), and ALCL (HR 0.40; 95%CI 0.24-0.68; p<0.001) subtypes. Compared to CHOEP, BVCHP significantly improved OS at 1 year (63% versus 56%; p<0.001), and 3 years (23% vs 10%; p=0.044). Results were similar with BVCHP versus CHOP.
Conclusions: Frontline BVCHP improved EFS and OS across major histologies. Studies examining the association between CD30 expression and survival have been initiated.
