title: Denileukin diftitox and hyper-CVAD in the treatment of human T-cell lymphotropic virus 1-associated acute T-cell leukemia/lymphoma.
abstract: We report a case of human T-cell lymphotropic virus 1 (HTLV-1)-associated adult T cell leukemia/lymphoma (ATL) in clinical remission > 1 year after therapy with denileukin diftitox and hyper-CVAD (hyperfractionated cyclophosphamide/doxorubicin/vincristine/decadron). The patient presented with leukocytosis, anemia, and thrombocytopenia, and bone marrow biopsy demonstrated extensive myelofibrosis and infiltration with leukemic T cells. Initial therapy with 4 cycles of denileukin diftitox resulted in restoration of normal hematopoiesis and a reduction in bone marrow myelofibrosis. After disease progression, 4 cycles of hyper-CVAD were administered and a complete clinical remission was achieved. The patient remains free of disease with normal hematopoiesis and has continued maintenance therapy with denileukin diftitox for 1 year. This case demonstrates clinical improvement of myelofibrosis and acute T-cell leukemia after denileukin diftitox administration, suggesting that denileukin diftitox may affect the paracrine secretion of HTLV-1-associated clinical manifestations of ATL.
authors.affiliation: Department of Hematology/Oncology, Tufts New England Medical Center, Boston, MA, USA.
authors.forename: Gina
authors.initials: G
authors.lastname: Di Venuti
authors.forename: Rangana
authors.initials: R
authors.lastname: Nawgiri
authors.forename: Francine
authors.initials: F
authors.lastname: Foss
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D001853:Bone Marrow / Q000378:metabolism; D001854:Bone Marrow Cells / Q000187:drug effects; D004167:Diphtheria Toxin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007376:Interleukin-2 / Q000627:therapeutic use*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004167:Diphtheria Toxin; D007376:Interleukin-2; D011993:Recombinant Fusion Proteins; C078456:denileukin diftitox