MODERN APPROACH TO THE TREATMENT OF T-CELL LYMPHOMA: A CLINICAL CASE OF USING HIGH-DOSE CHEMO AND TARGETED THERAPY

Abstract

Relevance: T-cell lymphomas are rare, aggressive non-Hodgkin lymphomas. Therapy for T-cell lymphomas remains a challenge for oncologists. In recent years, immunotherapy has developed greatly in the treatment of cancer. PD-L1 expression correlates with an unfavorable prognosis in many cancers; therefore, the prognostic value of PD-L1 levels in non-Hodgkin lymphomas is relevant. 

The study aimed to determine the level of PDL-1 expression in T-cell lymphomas using TPS and CPS analyses, and to analyze the correlation between expression levels and clinical and pathological features, as well as patient treatment outcomes.

Methods: A retrospective study of pathomorphological material from primary patients with T-cell lymphomas was conducted from 2015 to 2020. PD-L1 expression was determined using a modified combined positive score (CPS) and tumor share index (TPS). Clinical, laboratory, and instrumental data, as well as the results of therapy for patients included in the study, were collected. 

Results: The study included 40 patients; the average age was 48 years (range 18-76). 55% of patients were men, 45% were women. In 60% of cases, patients were under 60 years old. All patients received therapy according to the CHOP regimen (cyclophosphamide 750 mg/m2 on Day 1, doxorubicin 50 mg/m2 on Day 1, vincristine 1.3 mg/m2 on Day 1, and prednisolone 60 mg/m2 on Days 1-5). Complete remission was achieved in 12 patients, disease progression was observed in 19 patients, and 6 patients died from disease progression. PDL-1 overexpression was detected in 37 patients. Statistical correlation of PDL-1 expression with late-stage disease (p = 0.001), high IPI index (p = 0.001), high relapse rate (p = 0.001), and high serum LDH level (p = 0.001) was observed. PD-L1 expression was a prognostic factor affecting therapy outcome and prognosis. 

Conclusion: The significant increase in PDL-1 expression is a key prognostic factor and a predictor of poor response to standard therapy. The combination of two research types, CPS and TPS, more effectively detects PDL-1 expression, which is optimal given the biology of the tumor process. Immune therapy is a promising therapeutic option.