title: Case of a patient with progressive adult T-cell leukemia/lymphoma treated successfully by reduced-intensity conditioning stem cell transplantation from an HLA-incompatible related donor.
abstract: A 61-year-old man with progressive adult T-cell leukemia/lymphoma (ATLL) successfully received reduced-intensity conditioning stem cell transplantation (RIST) without T-cell depletion (TCD) from his HLA-incompatible son, who had negative results for human T-lymphotropic virus type 1 (HTLV-1) (1-locus, 1-allele mismatch in the graft-versus-host [GVH] direction; 2-loci, 1-allele mismatch in the host-versus-graft direction). The preparatory regimen consisted of fludarabine, busulfan, and rabbit antithymocyte globulin. GVH disease (GVHD) prophylaxis consisted of short-term administration of methotrexate, tacrolimus, and methylprednisolone. The patient achieved complete donor chimerism on day 30 after transplantation. On approximately day 50 the patient started to experience steroid-refractory skin GVHD (grade IV), which was successfully managed with basiliximab (anti-CD25 monoclonal antibody) and mycophenolate mofetil (MMF). Serial analysis of HTLV-1 proviral load by quantitative polymerase chain reaction analysis using whole peripheral blood demonstrated undetectable levels from day 90. At the time of this writing the patient had been in complete remission for more than 16 months. The results in this case suggest the potential of non-TCD RIST from an HLA-incompatible relative donor as an alternative source of hematopoietic stem cells even for an elderly patient with advanced ATLL. In addition, basiliximab combined with MMF may be effective for the treatment of steroid-refractory skin GVHD without deteriorating the graft-versus-ATL effect.
authors.affiliation: Division of Hematology Immunology, Internal Medicine, Kagoshima University Hospital, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kawada
authors.forename: Kakushi
authors.initials: K
authors.lastname: Matsushita
authors.forename: Heiichiro
authors.initials: H
authors.lastname: Hamada
authors.forename: Atsuo
authors.initials: A
authors.lastname: Ozaki
authors.forename: Hirosaka
authors.initials: H
authors.lastname: Inoue
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshimitsu
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Kukita
authors.forename: Kosei
authors.initials: K
authors.lastname: Arimura
authors.forename: Hideo
authors.initials: H
authors.lastname: Ohtsubo
authors.forename: Kimiharu
authors.initials: K
authors.lastname: Uozumi
authors.forename: Naomichi
authors.initials: N
authors.lastname: Arima
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
mesh_terms: D001402:B-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D006087:Graft vs Host Reaction; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D018183:Transplantation Chimera; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens