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

Abstract 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 × 10 9 /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.