Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study.
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.
Hishizawa
Masakatsu
M
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Kanda
Junya
J
Utsunomiya
Atae
A
Taniguchi
Shuichi
S
Eto
Tetsuya
T
Moriuchi
Yukiyoshi
Y
Tanosaki
Ryuji
R
Kawano
Fumio
F
Miyazaki
Yasushi
Y
Masuda
Masato
M
Nagafuji
Koji
K
Hara
Masamichi
M
Takanashi
Minoko
M
Kai
Shunro
S
Atsuta
Yoshiko
Y
Suzuki
Ritsuro
R
Kawase
Takakazu
T
Matsuo
Keitaro
K
Nagamura-Inoue
Tokiko
T
Kato
Shunichi
S
Sakamaki
Hisashi
H
Morishima
Yasuo
Y
Okamura
Jun
J
Ichinohe
Tatsuo
T
Uchiyama
Takashi
T
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