title: Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly used as a curative option for adult T-cell leukemia (ATL), an intractable mature T-cell neoplasm causally linked with human T-cell leukemia virus type I (HTLV-I). We compared outcomes of 386 patients with ATL who underwent allogeneic HSCT using different graft sources: 154 received human leukocyte antigen (HLA)-matched related marrow or peripheral blood; 43 received HLA-mismatched related marrow or peripheral blood; 99 received unrelated marrow; 90 received single unit unrelated cord blood. After a median follow-up of 41 months (range, 1.5-102), 3-year overall survival for entire cohort was 33% (95% confidence interval, 28%-38%). Multivariable analysis revealed 4 recipient factors significantly associated with lower survival rates: older age (> 50 years), male sex, status other than complete remission, and use of unrelated cord blood compared with use of HLA-matched related grafts. Treatment-related mortality rate was higher among patients given cord blood transplants; disease-associated mortality was higher among male recipients or those given transplants not in remission. Among patients who received related transplants, donor HTLV-I seropositivity adversely affected disease-associated mortality. In conclusion, allogeneic HSCT using currently available graft source is an effective treatment in selected patients with ATL, although greater effort is warranted to reduce treatment-related mortality.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Hishizawa
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.forename: Atae
authors.initials: A
authors.lastname: Utsunomiya
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Moriuchi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Fumio
authors.initials: F
authors.lastname: Kawano
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Masato
authors.initials: M
authors.lastname: Masuda
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hara
authors.forename: Minoko
authors.initials: M
authors.lastname: Takanashi
authors.forename: Shunro
authors.initials: S
authors.lastname: Kai
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawase
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Tokiko
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Jun
authors.initials: J
authors.lastname: Okamura
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D020544:Graft vs Leukemia Effect / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D015368:Human T-lymphotropic virus 1 / Q000378:metabolism / Q000472:pathogenicity; D006801:Humans; D007564:Japan / Q000453:epidemiology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000276:immunology / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous