Modified Newcastle Regimen Improves Survival Despite Central Nervous System Relapse in Monomorphic Epitheliotropic Intestinal T‐Cell Lymphoma
Minseung Suh, Hyungwoo Cho, Heounjeong Go, Jin‐Sook Ryu, Shin Kim, Kyoungmin Lee, Eun Jin Chae, Chan‐Sik Park, In Hye Song, Kyung Won Kim, Seok‐Byung Lim, In Ja Park, Chan Wook Kim, Yong Sik Yoon, Jaewon Hyung, Dok Hyun YoonABSTRACT
Background
Monomorphic epitheliotropic intestinal T‐cell lymphoma (MEITL) is a rare, aggressive malignancy with a median overall survival (OS) of 7–15 months. The Newcastle regimen, comprising cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), ifosfamide, etoposide, and epirubicin (IVE), and intermediate‐dose methotrexate for central nervous system (CNS) prophylaxis, has demonstrated promising outcomes in enteropathy‐associated T‐cell lymphoma (EATL) but has not been evaluated in MEITL, where the CNS relapse risk informing methotrexate use remains poorly characterized.
Methods
In this real‐world cohort of 56 patients with MEITL diagnosed from 2002 to 2025, outcomes were compared between those who received the modified Newcastle (mNewcastle) regimen omitting methotrexate (CHOP/IVE) and those treated with CHOP‐based chemotherapy. Survival was estimated using the Kaplan–Meier method with multivariable Cox regression, and CNS relapse was analyzed using a competing risks framework.
Results
Of 52 patients receiving systemic chemotherapy, 22 received the mNewcastle regimen and 28 received CHOP‐based chemotherapy, with comparable baseline characteristics. With a median follow‐up of 50 months, the mNewcastle was associated with significantly longer median progression‐free survival (PFS; 14.4 vs. 6.6 months, p = 0.021) and OS (28.7 vs. 11.7 months, p = 0.021). In multivariable analysis, mNewcastle remained an independent predictor of improved PFS (hazard ratio [HR], 0.44; p = 0.020) and showed a trend toward improved OS (HR, 0.51; p = 0.077). The 2‐year cumulative incidence of CNS relapse was 12.1% (95% CI, 2.9–21.4).
Conclusion
The mNewcastle regimen may provide superior survival compared with CHOP‐based chemotherapy in MEITL, while CNS relapse remains a clinical concern.
Trial Registration : The authors have confirmed clinical trial registration is not needed for this submission.