Outcomes of GDPT (gemcitabine, cisplatin, prednisone, thalidomide) versus CHOP in newly diagnosed peripheral T-cell lymphoma patients

Abstract

Aim: To compare the outcomes of GDPT [gemcitabine (G), cisplatin (D), prednisone (P), thalidomide (T)] versus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) in treating newly diagnosed PTCL (peripheral T-cell lymphoma). Methods: An open-label prospective clinical trial with 153 newly diagnosed PTCL patients conducted between January 2010 and December 2018 was designed. Patients were randomly assigned to the GDPT (77 cases) and CHOP (76 cases) groups. Patients in each group were further divided into four subgroups: PTCL, not otherwise specified (PTCL-NOS); anaplastic large cell lymphoma (ALCL), angioimmunoblastic T cell lymphoma (AITL), and other types subgroup, in accordance with pathological patterns. Based on expression of RRM1, TOP2A, TUBB3, and ERCC1, patients were divided into groups with high and low gene expression levels. Clinical characteristics, side effects, efficacy, progression-free survival (PFS), and overall survival (OS) were compared. Results: There were no significant differences in the basic clinical features or side effects between the GDPT and CHOP groups. The overall response rate (ORR) of the GDPT group was better than that of the CHOP group (66.3% versus 50.0%, p = 0.042), as was the complete remission (CR) rate (42.9% versus 27.6%, p = 0.049). Patients in the GDPT group had a longer PFS and OS than the CHOP group. The 4-year PFS and OS rates in the GDPT group were both superior to those in the CHOP group (63.6% versus 53.0% for PFS, p = 0.035; 66.8% versus 53.6% for OS, p = 0.039). In the GDPT group, the difference in CR between the four subgroups was statistically significant ( p = 0.046). In the CHOP group, differences in both CR and ORR among the four subgroups were statistically significant ( p < 0.001 and p = 0.005, respectively). There were also statistically significant differences in CR between patients treated with CHOP and GDPT in the PTCL-NOS subgroup, AITL subgroup, and the other types subgroup ( p = 0.015; p = 0.003; p = 0.005, respectively). The data also showed a significant difference in OS among the four subgroups within the GDPT group ( p = 0.001). The OS of AITL was shorter than that of the other three subgroups. Four subgroups of CHOP showed a significant difference in PFS ( p = 0.019). There was no statistical association between responses and the gene expression levels of RRM1, ERCC1, TUBB3, and TOP2A. Conclusion: The GDPT group had better response rates and prolonged patient PFS and OS. As a promising new regimen, GDPT is expected to become the first-line therapy for PTCL. New agents should be applied to patients who do not achieve good responses with previous treatment, such as those diagnosed with angioimmunoblastic T cell lymphoma. Trial registration: This open randomized prospective clinical trial was registered at ClinicalTrials.gov (NCT01664975).

NPM-ALK: A Driver of Lymphoma Pathogenesis and a Therapeutic Target

“…As it is less toxic than CHOP, it could be used for this type of patient [ 66 , 67 ]. Recently, a GDPT regimen, i.e., GDP added to thalidomide, has shown to be a new promising approach to treat patients with relapse and refractory PTCL including ALK(+)ALCL [ 68 ]. Indeed, GDP, composed of Gemcitabine (an antimetabolite), Cisplatin (an alkylating agent) and Prednisone, was previously used to treat relapsed or refractory patients affected by Peripheral T-cell lymphoma (PTCL), including ALCL.…”

Targeted Approaches to T-Cell Lymphoma

“…In the rare prospective upfront setting, a recent trial of 153 patients was reported demonstrating superiority of GDPT (gemcitabine, cisplatin, prednisone, and thalidomide) versus CHOP in previously untreated patients with PTCL, with respect to ORR (66.3% vs. 50.0%, p = 0.042), CR rate (42.9% vs. 27.6%, p = 0.049), 4-year PFS (63.6% vs. 53.0%, p = 0.035), and 4-year OS (66.8% vs. 53.6% for OS, p = 0.039). There were no differences in measured adverse effects between the two cohorts, with myelosuppression being the most common grade 3 or 4 AE [93].…”

Clinicopathologic analysis of nodal T-follicular helper cell lymphomas, a multicenter retrospective study from China

“…In a multicenter phase II study, Azacitidine and Romidepsin achieved an ORR of 80% (12/15) and a CRR of 60% (9/15) in T-FHCL patients. Our center has also conducted multiple clinical trials ( 25 , 26 ) showing promising results with certain regimens, such as “GDPT” (gemcitabine, cisplatin, prednisone, thalidomide) and “C-PET” (chidamide plus prednisone, etoposide, and thalidomide), which significantly improved disease remission rates and prolonged disease remission duration in nTFHL patients. Furthermore, ongoing research on the new regimen “ Das + AZA + CEP “ (Dasatinib, Azacitidine, Etoposide, Cyclophosphamide, Prednisone) for AITL treatment and the exploration of other new regimens aim to further enhance the therapeutic efficacy of this disease family.…”