Outcomes of CHOP versus CHOEP/EPOCH in aggressive adult T-cell leukemia/lymphoma: an international cohort analysis
In brief
Etoposide-containing chemo raises 3-year survival to 34% versus 12% in lymphomatous ATL
In a retrospective cohort of 328 adults with aggressive ATL, CHOEP/EPOCH improved three-year overall survival for lymphomatous disease (34% vs 12% with CHOP) while response rates were similar. No survival benefit was seen in acute ATL. The results suggest a subtype-specific advantage, but prospective trials are needed to confirm.
- Journal
- Haematologica (Q1)
- Published
- 10 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Bryan Valcarcel, Jule F Vasquez, Daniel Enriquez-Vera, Brady E Beltran, Denisse Castro, Thanya Runciman, et al.
- PMID
- 42719981
- DOI
- 10.3324/haematol.2026.300969
Why clinicians should know about it
- Picked for Hematology (paper of the day, 15 September 2026): CHOP vs CHOEP/EPOCH in aggressive ATL
Abstract
Aggressive adult T-cell leukemia/lymphoma (ATL) subtypes (i.e., acute and lymphomatous) are rare diseases, and the conventional management with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has historically yielded poor outcomes. The benefit of etoposide-containing regimens (CHOEP/EPOCH) in the first-line setting is inconclusive. We compared the effectiveness of CHOEP/EPOCH versus CHOP in aggressive ATL. We conducted an international, multicenter retrospective cohort study among newly diagnosed patients with ATL during 2000-2023 across five Latin American countries and the United States. Study endpoints included overall response rate (ORR) and overall survival (OS). Propensity score weighting was used to balance the treatment groups, and findings are reported for each ATL subtype. Among 328 patients, 108 had acute ATL and 220 had lymphomatous ATL. In weighted analyses, CHOEP/EPOCH was not statistically associated with a higher ORR compared to CHOP in lymphomatous ATL (66% vs. 58%; Odds ratio [OR]=2.08, 95% confidence interval [CI]=0.76-5.75) or acute ATL (42% vs. 58%; OR=0.68, 95% CI=0.06-7.84). With a median follow-up of 34 months (interquartile range [IQR] 15-73) in lymphomatous ATL, CHOEP/EPOCH was associated with a higher 3-year OS (34% vs. 12%; HR=0.55, 95% CI=0.35-0.87). However, with a median follow-up of 63 months (IQR 16-110) in acute ATL, CHOEP/EPOCH was not associated with improved 3-year OS (8% vs. 11%; HR=0.95, 95% CI=0.51-1.77). In conclusion, CHOEP/EPOCH may be associated with improved survival in lymphomatous ATL, while results in acute ATL were inconclusive. These findings support the need for prospective interventional studies to validate the subtype-specific benefits.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.