Abstract
Background:
Brentuximab vedotin (BV) showed high overall remission rate in refractory/relapsed classical Hodgkin's lymphoma (HL) and systemic anaplastic large cell lymphoma (sALCL). Although the efficacy of BV has been reported in clinical trials, its effectiveness in real-world treatment settings for patients with CD30 positive, aggressive sub types of non-Hodgkin's lymphoma (NHL) like peripheral T-cell lymphoma with T-follicular helper cell (TFH) phenotype (PTCL, TFH), anaplastic large-cell lymphoma (ALCL) and angioimmunoblastic T-cell lymphoma (AITL) in China has not been documented.
Methods
Analysis of a real-world, observational, retrospective case series in patients suffering from AITL, sALCL and PTCL-TFH treated with BV in different treatment lines was conducted. The patients were given treatment from May 2020 till 28 th June, 2021. All patients were pathologically diagnosed as PTCL before treatment and expressed CD30. Patients received BV (1.8 mg/kg) combined with CHP (cyclophosphamide, epirubicin, prednisone acetate every 3 weeks). The primary endpoint was the best curative effect and secondary endpoints were objective response rates (ORR), duration of remission, and incidence of adverse events (AEs). The expression level of CD-30 and its correlation with therapeutic effect was also evaluated.
Results
Out of a total of 21 patients (8 ALCL, 9 AITL, and 1 PTCL-TFH, 2 NK/T, 1 Mycosis fungoides (MF)), 18 patients (16 treatment naive, 2 relapsed) who completed ≥4 cycles of BV-CHP treatment were included for the evaluation of clinical effectiveness. Sixteen patients (90.6%) were identified with Ann Arbor stage III/IV, 14 (77.8%) patients had B symptoms (fever, drenching night sweats and loss of more than 10 percent of body weight over 6 months) and 14 (77.8%) patients had extra nodal infiltration. Further 12 patients had an International Prognostic Index (IPI) score of ≥3 and 13 patients (72.2%) had higher lactate dehydrogenase (LDH) values (table 1). All the patients had higher than normal β2-MG value (100%), which suggests that the patients may not derive benefits from monotherapy with chemotherapeutic agents. The overall ORR was 88.9% (CR:61.1%; PR: 27.8%). In the treatment naïve group, the ORR was 87.5% (CR: 62.5%; PR:25%), among whom the patients with ALCL had the best curative effect (CR 100%), with a duration of response of up to 8 months. In treatment naïve patients with AITL, the best response rate was 87.5%, while one patient had disease progression after 6 cycles of BV+CHP. The overall ORR in treatment naïve patients with AITL was 75% (CR: 25%; PR:50%), with the duration of response of up to 6 months. In the R/R group, ORR reached 100% (CR:50%; PR:50%) (Table 1). The CD30 expression level of ALCL was relatively high, and 80% of them had expression levels above 80%. The use of BV has achieved very significant curative effects. However, in AITL, the overall expression level was ranging from 2%-40%, and there is no obvious correlation with the therapeutic effect.
The most common adverse effects occurring in 5% of the patients were peripheral neuropathy, but no patients had neuropathy of grade 3 or above; the second most common adverse reaction was gastrointestinal reactions, including vomiting and diarrhea, especially in the AITL group.
Conclusion
BV is a promising treatment in patients with ALCL, AITL and PTCL-TFH in both first and refractory treatment settings.
No relevant conflicts of interest to declare.
