title: Use of zidovudine and interferon alfa with chemotherapy improves survival in both acute and lymphoma subtypes of adult T-cell leukemia/lymphoma.
abstract: OBJECTIVE
  Adult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-α) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis.
  
  
  METHODS
  We report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-α on treatment response and survival was assessed.
  
  
  RESULTS
  The overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-α). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-α at any time prolonged survival in acute (P < .001) and lymphoma ATLL (P < .001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone.
  
  
  CONCLUSIONS
  These data support the use of low-dose ZDV/IFN-α with chemotherapy in first-line treatment of acute and lymphoma ATLL.
authors: National Centre for Human Retrovirology, St Mary’s Hospital, Imperial College Healthcare National Health Service Trust, United Kingdom.
authors: Andrew
authors: A
authors: Hodson
authors: Siobhan
authors: S
authors: Crichton
authors: Silvia
authors: S
authors: Montoto
authors: Naheed
authors: N
authors: Mir
authors: Estella
authors: E
authors: Matutes
authors: Kate
authors: K
authors: Cwynarski
authors: Thurai
authors: T
authors: Kumaran
authors: Kirit M
authors: KM
authors: Ardeshna
authors: Antonio
authors: A
authors: Pagliuca
authors: Graham P
authors: GP
authors: Taylor
authors: Paul A
authors: PA
authors: Fields
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D016898:Interferon-alpha; D015215:Zidovudine