Frontline treatment strategies in peripheral T-cell lymphoma: A network meta-analysis of efficacy outcomes.

Abstract

e19065 Background: Peripheral T-cell Lymphomas (PTCLs) are rare, aggressive lymphoid malignancies with poor outcomes. Comparative data on frontline regimens are limited. This network meta-analysis evaluates the efficacy of CHOP, etoposide-based therapies, chemo-immunotherapy, high-dose therapy with hematopoietic stem cell transplant (HCT), and other chemotherapy combinations. Methods: A systematic review of PubMed, Scopus, and Cochrane Library (2000–2024) identified 45 studies (cohort studies and clinical trials). A Bayesian Network Meta Analysis using R v4.4.2 assessed overall response rate (ORR), complete response (CR), progression-free survival (PFS) and overall survival (OS) across five treatments, with HCT as the reference. Subgroup analyses for PTCL-NOS, angioimmunoblastic T cell lymphoma (AITL), and ALK negative-anaplastic large cell lymphoma (ALCL) were performed using Bayesian hierarchical modelling. Treatment effectiveness was evaluated using odds ratios (ORs), SUCRA rankings, and event probabilities. Results: The Bayesian NMA and SUCRA analysis indicated that OS was better with HCT consolidation (OR: 1.00, SUCRA: 98.7%), followed by etoposide-based chemotherapy (OR: 1.23, 95% CrI: 0.81–1.86; SUCRA: 76.7%). CHOP (OR: 1.82, 95% CrI: 1.25–2.64; SUCRA: 32.1%) and chemo-immunotherapy (OR: 2.44, 95% CrI: 1.15–5.18; SUCRA: 11.9%) showed higher odds of survival but ranked lower. HCT had the highest PFS ranking (OR: 1.00, SUCRA: 91.2%), followed by etoposide-based regimens (OR: 0.70, 95% CrI: 0.42–1.17; SUCRA: 66.0%). Chemo-immunotherapy (OR: 0.37, 95% CrI: 0.08–1.68; SUCRA: 26.0%) and CHOP (OR: 0.41, 95% CrI: 0.25–0.64; SUCRA: 15.5%) ranked lowest. For ORR, Chemo-immunotherapy had the highest SUCRA = (95.7%) but wide CrI (OR: 2.14, 95% CrI: 0.67–7.49). HCT had the highest CR (SUCRA: 92.3%), followed by other chemotherapy regimens (SUCRA: 81.4%) and chemo-immunotherapy (SUCRA: 57.5%). No incoherence was detected across the outcomes. In the PTCL-NOS subgroup, HCT showed the best OS probability (77%; 95% CI: 0.75–0.95), while CHOP ranked highest for PFS (47.6%, 95% CI: 0.34–0.61). with HCT having the lowest PFS probability (16.6%, 95% CI: 0.09–0.26). For the AITL subgroup , chemo-immunotherapy was most effective for OS (82.3%, 95% CI: 0.37–0.99) while CHOP, despite lower OS (61.3%) and ORR (76.3%), had the highest CR probability (72.7%, 95% CI: 0.32–0.99) and similar PFS probability to etoposide (52.6% vs. 52.8%). Lastly, amongst ALCL, HCT ranked highest for OS (69.6%, 95% CI: 0.53–0.83) and PFS (60.7%, 95% CI: 0.39–0.79), while CHOP had the highest ORR (93.4%, 95% CI: 0.84–0.99) and CR (82.8%, 95% CI: 0.69–0.93). Conclusions: HCT consolidation was the most effective treatment for OS, PFS, and CR overall, while chemo-immunotherapy had the highest OS in AITL, and CHOP ranked highest for PFS in PTCL-NOS and had the best CR in AITL and ALCL.