title: A critical analysis of prognostic factors in North American patients with human T-cell lymphotropic virus type-1-associated adult T-cell leukemia/lymphoma: a multicenter clinicopathologic experience and new prognostic score.
abstract: BACKGROUND
  To define the clinicopathologic and prognostic features of patients with human T-cell lymphotropic virus type-1 (HTLV-1)-associated adult T-cell leukemia/lymphoma (ATLL) in North America, standard criteria were used to identify patients with ATLL.
  
  
  METHODS
  Statistical analyses used included descriptive statistics, Kaplan-Meir survival analysis, and recursive partitioning.
  
  
  RESULTS
  Eighty-nine patients were identified between August 1992 and May 2007, including 37 (41.6%) males and 52 (58.4%) females with a median age of 50 years (range, 22-82 years). All but 6 patients had immigrated to the United States from the Caribbean, Latin America, or Africa. The acute subtype predominated (68.5%). The majority of patients received a combination-alkylator-based chemotherapy regimen in the front-line setting (72.6%). The most common regimen was cyclophosphamide, doxorubicin, vincristine, and prednisone at standard doses or attenuated and/or with methotrexate (CHOP-like), which produced an overall response rate of 64.1%. Despite initial responses to therapy, the median overall survival for all subtypes was 24 weeks (range, 0.9-315 weeks). Although the International Prognostic Index and Prognostic Index for peripheral T-cell lymphoma unspecified identified subsets of patients, these models were not completely predictive. A recursive partitioning analysis was performed on the data, which successfully identified 3 prognostic categories based on Eastern Cooperative Oncology Group performance status, stage, age, and calcium level at diagnosis.
  
  
  CONCLUSIONS
  This series proposed a new prognostic model for patients with HTLV-1-associated ATLL and confirmed a poor outcome for these patients in North America.
authors.affiliation: Division of Medical Oncology, Department of Medicine, Columbia University College of Physicians and Surgeons, Milstein Hospital Building, New York, New York 10032, USA. ap2027@columbia.edu
authors.forename: Adrienne A
authors.initials: AA
authors.lastname: Phillips
authors.forename: Iuliana
authors.initials: I
authors.lastname: Shapira
authors.forename: Robert D
authors.initials: RD
authors.lastname: Willim
authors.forename: Jasotha
authors.initials: J
authors.lastname: Sanmugarajah
authors.forename: William B
authors.initials: WB
authors.lastname: Solomon
authors.forename: Steven M
authors.initials: SM
authors.lastname: Horwitz
authors.forename: David G
authors.initials: DG
authors.lastname: Savage
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.forename: Gerald
authors.initials: G
authors.lastname: Soff
authors.forename: Jasmine M
authors.initials: JM
authors.lastname: Zain
authors.forename: Bachir
authors.initials: B
authors.lastname: Alobeid
authors.forename: Venkatraman E
authors.initials: VE
authors.lastname: Seshan
authors.forename: Owen A
authors.initials: OA
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D015368:Human T-lymphotropic virus 1; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014481:United States