A retrospective analysis of allogeneic hematopoietic stem cell transplantation for adult T cell leukemia/lymphoma (ATL): clinical impact of graft-versus-leukemia/lymphoma effect.
Adult T cell leukemia/lymphoma (ATL) is a highly aggressive T cell malignancy, and has a poor prognosis. Recently, allogeneic-hematopoietic stem cell transplantation (allo-HSCT) has been suggested to improve the outcome. We retrospectively analyzed 15 patients with ATL who had received allo-HSCT in 2 institutions in Hokkaido, Japan. The median age of the patients was 57 years. The estimated 3-year overall survival (OS) and progression-free survival (PFS) rates were 73.3% and 66.7%, respectively. Calcineurin inhibitor dosage was reduced and administration was discontinued abruptly in 6 of the 15 patients for disease control; as a result, 4 (66.7%) of the 6 patients achieved complete response (CR) or partial response. Therefore, a graft-versus-leukemia/lymphoma (GVL) effect might be induced by discontinuation of immunosuppression. Thirteen of the 15 patients were followed up by monitoring HTLV-1 proviral DNA levels. In 10 of the 11 patients with positive HTLV-1 proviral DNA before allo-HSCT, HTLV-1 proviral DNA became undetectable at least once after allo-HSCT, and only 1 of the 5 patients in whom HTLV-1 proviral DNA became detectable after allo-HSCT relapsed. Compared to the results of past studies, these results show that allo-HSCT greatly improved the prognosis of ATL and suggest a contribution of the induction of a GVL effect.
Shiratori
Souichi
S
Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, West 7 chome North 15 jo, North Ward, Sapporo, Japan. Sohichi.Shiratori@ma6.seikyou.ne.jp
Yasumoto
Atsushi
A
Tanaka
Junji
J
Shigematsu
Akio
A
Yamamoto
Satoshi
S
Nishio
Mitsufumi
M
Hashino
Satoshi
S
Morita
Rena
R
Takahata
Mutsumi
M
Onozawa
Masahiro
M
Kahata
Kaoru
K
Kondo
Takeshi
T
Ota
Shuichi
S
Wakasa
Kentaro
K
Sugita
Junichi
J
Koike
Takao
T
Asaka
Masahiro
M
Kasai
Masaharu
M
Imamura
Masahiro
M
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D020544:Graft vs Leukemia Effect; D015490:HTLV-I Infections / Q000097:blood / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D019562:Viral Load