Chidamide and Anlotinib Synergistically Inhibit High Grade B-Cell Lymphomas via PI3K/AKT Signaling Pathway

High-grade B-cell lymphoma with concurrent MYC and BCL2/BCL6 rearrangements (HGBL-DHL) presents a formidable challenge, often refractory and resistant to front-line immunochemotherapies, necessitating urgent exploration of novel therapeutic approaches. Herein, we unveiled a robust synergistic anti-lymphoma efficacy of chidamide and anlotinib against HGBL-DHL. The cooperative effect of cell proliferation inhibition, apoptosis induction, and cell cycle arrest were demonstrated in cell lines through Cell Counting Kit-8, and Annexin V/PI staining, respectively. Moreover, in an HGBL-DHL-xenografted mouse model, the combination therapy markedly reduced tumor burden without inducing fatal toxicity. Mechanistically, chidamide suppressed HDAC3, while anlotinib inhibited VEGFR2, leading to down-regulation of the PI3K/AKT signaling cascade. This dual suppression was by their synergistic effect. Collectively, our preclinical findings underscored the synergistic activity of chidamide and anlotinib combination against HGBL-DHL, warranting further clinical evaluation of this regimen for treating this challenging entity.