title: Adult T-cell leukemia developing during immunosuppressive treatment in a renal transplant recipient.
abstract: 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.
authors.affiliation: Department of Hematology/Oncology, University of Tokyo, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Tsurumi
authors.forename: K
authors.initials: K
authors.lastname: Tani
authors.forename: T
authors.initials: T
authors.lastname: Tsuruta
authors.forename: R
authors.initials: R
authors.lastname: Shirato
authors.forename: T
authors.initials: T
authors.lastname: Matsudaira
authors.forename: A
authors.initials: A
authors.lastname: Tojo
authors.forename: C
authors.initials: C
authors.lastname: Wada
authors.forename: H
authors.initials: H
authors.lastname: Uchida
authors.forename: K
authors.initials: K
authors.lastname: Ozawa
authors.forename: S
authors.initials: S
authors.lastname: Asano
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D002699:Chlorambucil; D004958:Estradiol; C036613:bestrabucil