Mitoxantrone liposome combined with EAC autologous transplant conditioning for the treatment of T/NK non-Hodgkin's lymphoma

Abstract Objectives: New drug combination therapy can improve the survival rate of patients with T-cell lymphoma, but autologous hematopoietic stem cell transplantation (HSCT) is still indispensable. There is currently no standard pretreatment protocol for Auto-HSCT. Existing conditioning regimens have limited efficacy, with a 3-year progression-free survival rate ranging from 40% to 50%. Mitoxantrone hydrochloride liposomes brings a new treatment option for patients with relapsed and refractory PTCL. We evaluate the efficacy and safety of mitoxantrone liposomal-EAC conditioning combined with ASCT in the treatment of T/NK non-Hodgkin's lymphoma. Methods: The study retrospectively analyzed the data of T/NK cell lymphoma patients who underwent autologous hematopoietic stem cell transplantation from January 2023 to December 2024 in Xinqiao Hospital of the Army Medical University, and the transplant pretreatment regimen was: intravenous infusion of mitoxantrone hydrochloride liposomal 24mg/m2on the 7th day before autologous stem cell reinfusion; Etoposide 150 mg/m2 daily from day 6 to day 3 before reinfusion; Cytarabine 150 mg/m2 2 times/day from day 6 to day 3 before reinfusion; Cyclophosphamide 1.0 g/m2 daily from day 6 to day 3 before reinfusion. Results: A total of 13 patients with T/NK cell lymphoma underwent ASCT. Baseline characteristics include: median age 39 years (range 31-61); Male: Female = 7:6; 10 cases with disease stage III-IV; 5 cases of ENKTL, 3 cases of AITL, 2 cases of ALK-ALCL, 2 cases of PTCL-NOS, 1 case of T-LBL, IPI 3-5=1, and the efficacy PR = 3 and CR=10 before receiving HSCT. The median number of CD34 cells infused was 4.08 (range: 2.90-9.82×106/kg). The median time for hematopoietic reconstruction, neutrophil and platelet engraftment was 12 days for all patients. Most non-hematologic adverse events (AEs) were grade 1/2, and grade 3 AEs were febrile neutropenia in 7 patients. The complete response rate of PET-CT at 100 days after ASCT was 92.3%, and 1 patient progressed. The 1-year PFS was 79.5% and the 1-year OS was 83.3%. Conclusion: Mitoxantrone liposomes combined with EAC conditioning for transplantation of T/NK non-Hodgkin lymphoma are safe and effective, and well tolerated, and the implantation kinetics have not changed, but further follow-up and expanded sample size evaluation are needed.