The efficacy and survival impact of chidamide on angioimmunoblastic T-cell lymphoma based on Epstein-Barr virus stratification in the real world: A multicenter study.

Epstein-Barr virus (EBV) infection is frequently observed in angioimmunoblastic T-cell lymphoma (AITL), yet its prognostic and therapeutic implications remain unclear. This multicenter real-world study analyzed 155 newly diagnosed AITL patients (117 EBV-encoded RNA-positive [EBER+] and 38 EBER-negative [EBER-]) from Chinese institutions between 2012 and 2022. EBER+ cases demonstrated significantly higher Ki67 proliferation indices and CD30 expression compared to EBER- cases (p = .013 and p = .045, respectively). While no survival difference was observed between EBER+ and EBER- groups (overall survival [OS] p = .16; progression-free survival [PFS] p = .43), chidamide-combined chemotherapy significantly improved outcomes exclusively in EBER+ patients (OS p = .014; PFS p = .0018) with no benefit seen in EBER- cases (OS p = .98; PFS p = .83). Multivariate analysis identified distinct risk factors by EBV status. Older age (≥60), thrombocytopenia (<150 × 109/L) and nasopharyngeal involvement independently predicted poor prognosis in EBER+ patients, whereas B symptoms were prognostic in EBER- cases. These findings suggest that EBER+ and EBER- AITL may represent distinct disease entities. EBV infection appears to influence disease progression and prognosis in EBER-positive patients, whereas EBER-negative cases more closely align with the disease characteristics observed in other peripheral T-cell lymphomas. The results suggest that stratifying patients by EBV status is crucial for optimizing AITL clinical management.