Adult T-cell leukemia developing during immunosuppressive treatment in a renal transplant recipient.
We report a case of a 32-year-old male, an asymptomatic carrier of human T-cell leukemia virus type 1 (HTLV-1), who underwent a renal transplantation and developed adult T-cell leukemia (ATL) during the course of posttransplant immunosuppressive treatment. He was treated with combination chemotherapies consisting of cyclophosphamide, vincristine, doxorubicin, prednisolone, cisplatin, cytosine arabinoside, etoposide, and methyl-prednisolone, without any improvement. Bestrabucil (KM2210), a conjugate of chlorambucil and estradiol, was administered as an alternative therapy; this therapy successfully suppressed his leukemic cell growth, and partial remission was achieved. Posttransplant immunosuppressive therapy with prednisolone, mizoribine, and cyclosporin A might have been the predominant cause of the transition from an asymptomatic HTLV-1 infection to overt ATL. A careful approach is required with HTLV-1 asymptomatic carriers who need organ transplantation followed by immunosuppressive treatment.
Tsurumi
H
H
Department of Hematology/Oncology, University of Tokyo, Japan.
Tani
K
K
Tsuruta
T
T
Shirato
R
R
Matsudaira
T
T
Tojo
A
A
Wada
C
C
Uchida
H
H
Ozawa
K
K
Asano
S
S
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002353:Carrier State; D002699:Chlorambucil / Q000031:analogs & derivatives / Q000627:therapeutic use; D004958:Estradiol / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D016030:Kidney Transplantation; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy / Q000209:etiology*; D008297:Male
D000970:Antineoplastic Agents; D002699:Chlorambucil; D004958:Estradiol; C036613:bestrabucil