DA-Edoch Regimen As First-Line Treatment Could Significantly Improve the Early Efficacy of Adult T-Cell Leukemia/Lymphoma

Abstract

OBJECTIVE: Adult T-cell leukemia/lymphoma (ATLL) is a rare and unique T cell malignancy with generally inferior clinical response to current chemotherapy and extremely poor prognosis. Optimizing chemotherapy is considered as the key to improve the efficacy. This study attempted to use DA-EDOCH regimen (etoposide, dexamethasone, vincristine, cyclophosphamide, doxorubicin) as the first-line chemotherapy regimen to treat ATLL patients. Efficacy and safety was evaluated and those curative impact factors were analyzed.METHODS: The ATLL patients, who visited Fujian Medical University Union Hospital and received at least one course of DA-EDOCH regimen from December 2014 to July 2018, were enrolled. The clinical characteristics, clinical response and adverse events were collected for analyzing the efficacy and safety of DA-EDOCH regimen.RESULTS: A total of 16 patients were enrolled, including 14 patients treated with DA-EDOCH regimen as first-line treatments and 2 patients as second-line treatments. The male-female ratio was 3:2 and the median age was 53 (28-65) years. There were 11 cases of acute type and 5 cases of lymphoma type. Of the 16 patients, 1 was unevaluable, and the remaining 15 patients were available for efficacy assessment. The objective response rate (ORR) was 86.7% (13/15), of which the complete remission (CR) rate was 40.0% (6/15) and the partial response rate (PR) was 46.7% (7/15), which was similar to the modified LSG(mLSG) regimen in Japan (CR rate is 40.0%). The median overall survival (OS) time of the 16 patients was 12.3 (0.9-43.4) months, and the 1-year OS rate and progression-free survival (PFS) rate were 53.8% and 47.1%, respectively; the 3-year OS and PFS was 44.9% and 37.7%, respectively, which produced preferable prognosis compared to the mLSG regimen (median survival time was 12.7 months and 3-years OS was 24.0%). It showed no statistically distinguished prognosis between lymphoma type and acute type (P=0.709), which the median OS time at 12.7 (0.9-40.3) months and 11.8 (1.2-43.4) months, respectively, and the 3-year OS at 60.0% and 40.4%, respectively. 4 of the 6 patients reaching CR underwent hematopoietic stem cell transplantation(HSCT). Three of them underwent allogeneic HSCT and were currently still alive with a median OS time of 43.0 (18.2-43.4) months. The rest 1 patient received autogenetic HSCT, but relapsed 1 month after the transplantation and died two months after recurrence. 9 of the 15 patients with ORR relapsed, with the recurrence rate of 60.0% (9/15). The recurrence may be related to the untimely treatment due to not following medical advice. During chemotherapy, grade 4 neutropenia, grade 4 thrombocytopenia, and grade 3 or 4 infection rates were 62.5% (10/16), 18.8% (3/16), and 75.0% (12/16), respectively. No serious liver, kidney or heart function damage happened while treatment and disease progression related death occurred in 2 patients.Conclusion: The DA-EDOCH regimen could improve the early efficacy of patients with ATLL. Further allogeneic hematopoietic stem cell transplantation after CR may bring better long-term outcomes to patients. DisclosuresNo relevant conflicts of interest to declare.