title: Treatment of relapsed adult T-cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: the Nagasaki Transplant Group experience.
abstract: Adult T-cell leukemia/lymphoma (ATL) relapse is a serious therapeutic challenge after allogeneic hematopoietic stem cell transplantation (allo-SCT). In the present study, we retrospectively analyzed 35 patients who experienced progression of or relapsed persistent ATL after a first allo-SCT at 3 institutions in Nagasaki prefecture (Japan) between 1997 and 2010. Twenty-nine patients were treated by the withdrawal of immune suppressants as the initial intervention, which resulted in complete remission (CR) in 2 patients. As the second intervention, 9 patients went on to receive a combination of donor lymphocyte infusion and cytoreductive therapy and CR was achieved in 4 patients. Of 6 patients who had already had their immune suppressants discontinued before the relapse, 3 patients with local recurrence received local cytoreductive therapy as the initial treatment, which resulted in CR for more than 19 months. Donor lymphocyte infusion-induced remissions of ATL were durable, with 3 cases of long-term remission of more than 3 years and, interestingly, the emergence or progression of chronic GVHD was observed in all of these cases. For all 35 patients, overall survival after relapse was 19.3% at 3 years. The results of the present study suggest that induction of a graft-versus-ATL effect may be crucial to obtaining durable remission for ATL patients with relapse or progression after allo-SCT.
authors.affiliation: Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Itonaga
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsushima
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukushima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Sato
authors.forename: Koji
authors.initials: K
authors.lastname: Ando
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Sawayama
authors.forename: Emi
authors.initials: E
authors.lastname: Matsuo
authors.forename: Reishi
authors.initials: R
authors.lastname: Yamasaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Onimaru
authors.forename: Daisuke
authors.initials: D
authors.lastname: Imanishi
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Imaizumi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hata
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Moriuchi
authors.forename: Naokuni
authors.initials: N
authors.lastname: Uike
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D020544:Graft vs Leukemia Effect; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan; D053208:Kaplan-Meier Estimate; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy* / Q000601:surgery; D017254:Leukemic Infiltration; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D012867:Skin / Q000473:pathology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents