Development of a modified prognostic index for patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: possible risk-adapted management strategies including allogeneic transplantation.
Adult T-cell leukemia-lymphoma is a distinct type of peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I. Although allogeneic stem cell transplantation after chemotherapy is a recommended treatment option for patients with aggressive adult T-cell leukemia-lymphoma, there is no consensus about indications for allogeneic stem cell transplantation because there is no established risk stratification system for transplant eligible patients. We conducted a nationwide survey of patients with aggressive adult T-cell leukemia-lymphoma in order to construct a new, large database that includes 1,792 patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who were diagnosed between 2000 and 2013 and received intensive first-line chemotherapy. We randomly divided patients into two groups (training and validation sets). Acute type, poor performance status, high soluble interleukin-2 receptor levels (> 5,000 U/mL), high adjusted calcium levels (≥ 12 mg/dL), and high C-reactive protein levels (≥ 2.5 mg/dL) were independent adverse prognostic factors used in the training set. We used these five variables to divide patients into three risk groups. In the validation set, median overall survival for the low-, intermediate-, and high-risk groups was 626 days, 322 days, and 197 days, respectively. In the intermediate- and high-risk groups, transplanted recipients had significantly better overall survival than non-transplanted patients. We developed a promising new risk stratification system to identify patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who may benefit from upfront allogeneic stem cell transplantation. Prospective studies are warranted to confirm the benefit of this treatment strategy.
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan s-fuji@pj8.so-net.ne.jp.|Juntendo University Graduate School of Medicine, Tokyo, Japan.
Shigeo
S
Fuji
Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan.
Takuhiro
T
Yamaguchi
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.|Juntendo University Graduate School of Medicine, Tokyo, Japan.|Department of Hematology, Kumamoto University Hospital, Kagoshima, Japan.
Yoshitaka
Y
Inoue
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan.
Atae
A
Utsunomiya
Department of Hematology, Sasebo City General Hospital, The University of Tokyo, Japan.
Yukiyoshi
Y
Moriuchi
Department of Hematology/Oncology, Institute of Medical Science, The University of Tokyo, Japan.
Kaoru
K
Uchimaru
Department of Hematology, National Hospital Organization Kagoshima Medical Center, Okinawa.
Satsuki
S
Owatari
Department of Hematology, Heart-Life Hospital, Okinawa, Japan.
Takashi
T
Miyagi
Department of Hematology, Nagasaki University Hospital, Fukuoka, Japan.
Jun
J
Taguchi
Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Ilseung
I
Choi
Department of Hematology, Oita Prefectural Hospital, Okinawa, Japan.
Eiichi
E
Otsuka
Second Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan.
Sawako
S
Nakachi
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Hisashi
H
Yamamoto
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Saiko
S
Kurosawa
Juntendo University Graduate School of Medicine, Tokyo, Japan.|Department of Hematology, National Cancer Center Hospital, Tokyo, Japan.
Kensei
K
Tobinai
Department of Hematology, Nagasaki University Hospital, Fukuoka, Japan.
Takahiro
T
Fukuda
D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D016208:Databases, Factual; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D019538:Health Care Surveys; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007564:Japan; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult
D015415:Biomarkers