| Abstract: |
Hepatosplenic T-cell lymphoma (HSTCL) is a rare peripheral T-cell lymphoma that carries a poor prognosis without a well-established treatment regimen. We conducted the largest-to-date individual-level meta-analysis to determine optimal induction therapy for HSTCL. Non-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-based induction was superior to CHOP/CHOP-like induction in achieving complete or partial remission and durable survival. Induction therapy of HSTCL should be intensified with non-CHOP-based regimens. © 2019 Elsevier Inc. Introduction: Hepatosplenic T-cell lymphoma (HSTCL) is a rare peripheral T-cell lymphoma that disproportionately affects individuals with a clinical history of immunosuppression. It carries a poor prognosis, and, owing to its rarity, there is no single or well-established treatment. Patients and Methods: We conducted the largest-to-date individual-level meta-analysis based on literature searches to determine the best induction therapy for HSTCL. We compared response rates and survival among patients who received “non–CHOP-based” induction with regimens containing cytarabine, etoposide, and/or platinum-based treatment to those receiving treatment with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP-like therapy. We also review additional regimens including alemtuzumab and pentostatin, and assessed the role of consolidation with hematopoietic stem-cell transplantation (HSCT). Results: We identified 166 patients with HSTCL, 118 of whom had sufficient information on induction treatment and survival. Eighty-four patients received non-CHOP-based (N = 34) or CHOP/CHOP-like (N = 50) induction treatment. Non-CHOP-based induction was associated with a complete/partial response rate of 82% compared with 52% (P =.006) with CHOP/CHOP-like and increased median overall survival (P =.00014). Our data showed that maximum survival among patients with HSTCL was achieved with non-CHOP-based induction followed by consolidation with HSCT. Conclusions: Non-CHOP-based induction appears superior to CHOP/CHOP-like induction in both achieving complete/partial response and durable survival. Induction therapy of HSTCL should be intensified with non-CHOP-based regimens and followed by consolidation with HSCT in eligible patients. © 2019 Elsevier Inc. |
