Final results of a phase II study of CHOEP plus lenalidomide as initial therapy for patients with stage II–IV peripheral T‐cell lymphoma

• Published in: British journal of haematology 2023-08, Vol.202 (3), p.525-529
• Main Authors: Stuver, Robert, Horwitz, Steven M., Advani, Ranjana H., Vose, Julie M., Lee, Hun Ju, Mehta‐Shah, Neha, Zain, Jasmine M., Haverkos, Bradley, Lechowicz, Mary Jo, Moskowitz, Alison J., Pham, Luu Q., Leyden, Elizabeth, Ansell, Stephen M., Lunning, Matthew A.
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; clinical trials; Growth factors; Hematology; Humans; Immunotherapy; Lenalidomide; Lymphoma; Lymphoma, T-Cell, Peripheral - drug therapy; lymphomas; malignant lymphomas; Neutropenia; non‐Hodgkins lymphoma; Remission Induction; Response rates; T-cell lymphoma; Targeted cancer therapy; Toxicity; trials
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/bjh.18885

Summary There remains no one standard induction for nodal‐based peripheral T‐cell lymphoma (PTCL). We conducted a phase II study of lenalidomide plus CHOEP as a novel induction strategy. Patients received CHOEP at standard doses in combination with 10 mg of lenalidomide on days 1–10 of a 21‐day cycle for six cycles of therapy followed by observation, high‐dose therapy with autologous stem cell rescue, or maintenance lenalidomide per provider preference. Among 39 patients evaluable for efficacy, the objective response rate after six cycles was 69%, with complete response in 49%, partial response in 21%, stable disease in 0% and progressive disease in 13%. Thirty‐two patients (82%) completed full induction, and seven patients (18%) discontinued for toxicity, primarily hematologic. Any grade hematologic toxicity occurred in over 50% of patients, with grade 3 or 4 febrile neutropenia occurring in 35% of patients despite mandated growth factors. With a median followup of surviving patients of 21.3 months, the estimated 2‐year progression‐free and overall survival were 55% (95% CI 37%–70%) and 78% (95% CI 59%–89%), respectively. In sum, six cycles of lenalidomide plus CHOEP resulted in a modest response rate primarily due to hematologic toxicity, which prevented all patients from completing planned induction.