Evaluation of the efficacy and safety of first-line therapies for peripheral T-cell lymphoma: a systematic review and network meta-analysis.

OBJECTIVE: To compare the efficacy and safety of first-line therapies for peripheral T-cell lymphoma (PTCL) via network meta-analysis. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) evaluating first-line treatments in untreated PTCL patients (up to March 1, 2025). Two investigators independently screened studies, extracted data, and assessed bias risk. Network meta-analysis was performed using R (v4.3.0). RESULTS: Seven RCTs (1,334 patients) were included, evaluating CHOP, VIP-rABVD, GEM-P, A+CHP, GDPT, Ro-CHOP, and ICED. No significant differences were found in overall or progression-free survival. However, A+CHP (OR = 1.90, 95%CI:1.20-3.10) and GDPT (OR = 2.00, 95%CI:1.00-3.80) showed higher objective response rates versus CHOP. A+CHP (OR = 1.76, 95%CI:1.09-2.88) and Ro-CHOP (OR = 1.40, 95%CI:1.00-1.80) achieved better disease control. VIP-rABVD had the highest thrombocytopenia risk (OR = 50.0, 95%CI:14.29-100), while ICED showed increased anemia risk (OR = 9.20, 95%CI:2.80-44.0). Subgroup analyses revealed no significant PFS differences in AITL/PTCL-NOS. CONCLUSION: A+CHP shows superior efficacy with acceptable toxicity, while GDPT improves responses but increases myelosuppression risk. Ro-CHOP enhances disease control but with limited remission depth and higher toxicity. Subtype analyses suggest potential PFS benefits for Ro-CHOP in AITL. For PTCL of unspecified type (PTCL-NOS), there is little difference in efficacy among the various treatment regimens.A+CHP and GDPT offer optimal benefit-risk profiles.