Real-World Efficacy of 5-Azacytidine as Salvage Chemotherapy for Angioimmunoblastic T-cell Lymphoma

• Published in: Clinical lymphoma, myeloma and leukemia Vol. 22; no. 11; pp. e972 - e980
• Main Authors: Yoon, Sang Eun, Cho, Junhun, Kim, Yeon Jeong, Kim, Seok Jin, Kim, Won Seog
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2022
• Subjects: 5-azacytidine; Angioimmunoblastic T-cell lymphoma; Epigenetic mutation; 5-azacytidine; Angioimmunoblastic T-cell lymphoma; Epigenetic mutation
• ISSN: 2152-2650; 2152-2669; 2152-2669
• DOI: 10.1016/j.clml.2022.07.009

Based on specific epigenetic mutation in AITL such as TET2, DNMT3A, IDH2, and RHOA, hypomethylating agents are emerging as a promising treatment option for AITL. The efficacy and safety of 5-azacytidine as salvage chemotherapy were retrospectively analyzed in 15 patients with RR-AITL from 2019 to 2022. During the median 6.0 months of follow-up, the overall response rate (ORR) was 40% (n = 6/15) with 2 CRs and 4 PRs. The patients who previously had received ≤2 prior chemotherapies showed higher ORR than subjects with >2 prior chemotherapies (80% vs. 20%). The 10 patients who received 5-azacitidine at the late chemotherapy lines (>2 prior chemotherapy lines) usually received less dose 5-azacitidine. And these patients discontinued treatment due to disease progression (n = 6/10, 60%) or neutropenic fever (n = 4/10, 40%). The patients who received a full dose (75 mg/m2 for 7 days) of 5-azacitidine seemed to show better ORR than subjects (100 mg for 7 days) who did not receive an optimal dose (60.0% vs. 30.0%). The median progression-free survival (PFS) was 1.6 months, and the patients who previously had undergone ≤2 chemotherapies had better PFS compared with subjects who previously received >2 chemotherapies (P-value = .04). 5-azacitidine shows reasonable efficacy and manageable toxicities for patients with RR-AITL, especially those who previously received ≤2 chemotherapy lines. We performed the retrospective study with 15 relapsed/refractory AITL patients to assess the role of 5-azacitidine. The patients treated with 5-azacitidine showed a 40% overall response rate, and especially those who previously underwent ≤2 chemotherapies showed better ORR (60% vs. 30%). Thus, 5-azacitidine is a reasonable treatment option for RR-AITL, especially for those who previously received ≤2 chemotherapy lines.