Objective:To investigate the efficacy and safety of chidamide in the maintenance therapy for patients with T-cell lymphoma (TCL).Methods:A prospective, single-arm clinical study was conducted. A total of 53 TCL patients who achieved partial remission (PR) and above after first-line induction chemotherapy in the Second Affiliated Hospital of Army Military Medical University from May 2018 to July 2020 were included, among which 28 cases underwent autologous hematopoietic stem cell transplantation after induction chemotherapy, and then received maintenance therapy with chidamide initiating 30 to 45 days after transplantation (the transplantation group); 25 cases began to receive maintenance therapy with chidamide about 30 days after 6 to 8 courses of first-line induction chemotherapy (non-transplantation group). Chidamide usage was listed as follows: oral, 20-30 mg per time, 2 times per week, at intervals of not less than 3 d and the therapy was maintained for 2 years or until disease progression or intolerance. The main study endpoint was the 2-year recurrence rate, and the secondary study endpoints included the 1-year recurrence rate, the 1- and 2-year progression free survival (PFS) rate, the 1- and 2-year overall survival (OS) rate, and the safety of maintenance therapy.Results:The median follow-up was 13.5 months (range 5 to 51 months). After 6 to 8 courses of first-line induction chemotherapy in 53 patients with TCL, complete remission (CR) was achieved in 29 (54.7%) cases and PR in 24 (45.3%) cases. The proportion of patients aged ≤ 60 years and those achieving CR before maintenance treatment in the transplantation group was higher than that in non-transplantation group (both P < 0.05). During maintenance therapy, the best remission reached CR in 84.9% (45/53) of patients; CR rates during maintenance therapy were 89.3% (25/28) and 80.0% (20/25), respectively in the transplantation and non-transplantation groups; and PR rates were 10.7% (3/28), and 20.0% (5/25) ( χ2 = 0.31, P = 0.577). Among the 53 patients with TCL, 21 cases had recurrence with a 1-year recurrence rate of 26.4% (14/53) and a 2-year recurrence rate of 39.6% (21/53). The 2-year recurrence rates were 42.9% (12/28) and 36.0% (9/25), respectively in the transplantation and non-transplantation groups, and the difference was not statistically significant ( χ2 = 0.26, P = 0.610). The 1-year recurrence rates of patients receiving chidamide maintenance therapy with different international prognostic index (IPI) scores and whether achieving CR before maintenance therapy or not showed statistically significant differences (all P < 0.05); the 2-year recurrence rates of patients receiving chidamide maintenance therapy with different IPI scores, bone involvement or not and whether achieving CR before maintenance therapy or not showed statistically significant differences (all P < 0.05). The 1-year PFS and OS rates were 80.7% and 88.6%, and the 2-year PFS and OS rates were 61.1% and 71.9% in 53 patients. The 1-year PFS rates of patients in the transplantation and non-transplantation groups were 81.1% and 80.2% ( P = 0.774), and the 1-year OS rates were 89.3% and 87.4%, respectively ( P = 0.736). The 2-year PFS rates were 60.4% and 61.3% ( P = 0.440), and the 2-year OS rates were 72.7% and 70.6% ( P = 0.510). No patient discontinued chidamide maintenance therapy due to adverse drug reactions during maintenance therapy; ≥ grade 3 adverse drug reactions included neutropenia (9 cases, 23.1%), anemia (7 cases, 17.9%), thrombocytopenia (6 cases, 16.2%) and electhrolyte disturbance (1 case, 5.3%). The chidamide dosage was adjusted to 20 mg per time due to leucopenia in 7 patients and thrombocytopenia in 3 patients. Conclusions:Maintenance therapy with chidamide can reduce recurrence rate and prolong survival time of TCL patients, and it has a favorable safety.

Peripheral T-cell lymphoma(PTCL)is a group of hematological malignant tumors with high heterogeneity.At present,CHOP(cyclophosphamide,vincristine,prednisone,doxorubicin)or CHOP-like regimens are usually used for first-line treatment,but the remission rate is low,and the prognosis is poor.It is urgent to improve the traditional chemotherapy regimens to improve the efficacy onthe basis of tradtional che-motherapeutic regimen.Recent studies have found that the epigenetic alterations are crucial in the pathogene-sis of PTCL,and more and more new epigenetic targeted drugs have shown good effects and safety in the monotherapy and combination therapy of PTCL,which provide a new strategy for the precise diagnosis and treatment of PTCL.This article reviews the latest progress in epigenetic changes of PTCL and the prospects of targeted drug therapy applications,in order to provide reference for improving the clinical prognosis of the patients with PTCL.

Ruxolitinib， a small molecule inhibitor， selectively targets Janus kinase （JAK） by competitively binding to adenosine triphosphate on the catalytic site of the JAK1 and JAK2 domain， thereby inhibiting JAK activation and signal transducer and activator of transcription （STAT） phosphorylation and prevents the expressions of the JAK-STAT signaling pathway. Oral ruxolitinib has demonstrated promising efficacy for myelofibrosis and polycythemia vera. The topical Ruxolitinib cream， approved by the US FDA as the first non-segmental vitiligo home treatment drug， is set to be launched in domestic medical pioneer areas in August 2023 and is expected to bring about a breakthrough in the treatment of vitiligo. Clinical cases have also shown that Ruxolitinib cream has significant curative effects on atopic dermatitis， alopecia areata， and other conditions， indicating great application prospects.