title: A retrospective analysis of treatment outcomes in adult T cell leukemia/lymphoma patients with aggressive disease treated with or without allogeneic stem cell transplantation: A single-center experience.
abstract: Adult T cell leukemia/lymphoma (ATL) is an aggressive peripheral T cell neoplasm with very poor prognosis. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been reported as a curative treatment modality for ATL. However, there are no reports comparing chemotherapy alone with allo-HSCT in ATL. In this report, we retrospectively analyzed data for patients treated with (n = 29, median age 55 years) or without allo-HSCT (n = 37, median age 58 years) for ATL in Kagoshima University Hospital, located in one of the most endemic areas of human T cell lymphotropic leukemia virus type 1 infection. Forty patients (61%) started coordination for allo-HSCT. Ten patients (34.4%) received allo-HSCT while in complete remission (CR), whereas the others were not in CR. Twenty-five patients (86.2%) received reduced-intensity conditioning, and the others received myeloablative conditioning. With a median follow-up period for survivors of 41 months (range, 5 to 125 months), the 3-year overall survival (OS) rate from first chemotherapy for all patients (with or without allo-HSCT) was 35.2%. The 3-year OS from first chemotherapy for patients who received allo-HSCT or only chemotherapy was 44.9% and 27.7%, respectively. Univariate analyses revealed that high serum soluble IL-2 receptor (sIL-2R) levels (≥ 2000 U/mL) just before the conditioning regimen and progressive disease (PD) status at HSCT (according to Japan Clinical Oncology Group Study 0907 criteria) were significant risk factors for OS in the allo-HSCT group. Multivariate analyses revealed that PD status was a significant risk factor for OS in the allo-HSCT group. In the chemotherapy-only group, the 3-year OS rate was 61.5% (95% CI, 30.8% to 81.8%) in patients with serum sIL-2R levels < 2000 U/mL for > 3 months. In contrast, the 3-year OS rate was 5.7% (95% CI, .4% to 22.4%) in patients who did not achieve serum sIL-2R levels < 2000 U/mL for >3 months. Our single-center cohort experience indicates that chemosensitivity is the most important prognostic factor for OS in ATL patients and the use of allo-HSCT is limited in chemorefractory patients with aggressive ATL disease. In the chemosensitive patients, allo-HSCT demonstrated a tendency toward better OS. Further clinical studies are warranted to determine optimal treatments for patients who are less sensitive to conventional chemotherapy.
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kawada
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan; Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan. Electronic address: myoshimi@m.kufm.kagoshima-u.ac.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshimitsu
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan; Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakamura
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan; Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Arai
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Hayashida
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kamada
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Maekawa
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Fujino
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Mamiko
authors.initials: M
authors.lastname: Arima
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Naosuke
authors.initials: N
authors.lastname: Arima
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tabuchi
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Hirosaka
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Heiichiro
authors.initials: H
authors.lastname: Hamda
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors.forename: Kakushi
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Department of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan; Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
authors.forename: Naomichi
authors.initials: N
authors.lastname: Arima
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D015368:Human T-lymphotropic virus 1; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents
keywords: Adult T cell leukemia/lymphoma; Allogeneic stem cell transplantation