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.

Adult T-cell leukemia/lymphoma in the Caribbean cohort is a distinct clinical entity with dismal response to conventional chemotherapy

“…A recent non-Japanese ATLL study found improved outcomes in patients who underwent allo-HSCT in comparison to autologous transplant [17], and early application of HSCT may be beneficial [28]. The timing and patient selection for allo-HSCT remain controversial, as its utility could be limited in patients with progressive disease [29]. Based on our experience demonstrating a poor overall survival in these patients, and evidence of a graft vs. lymphoma effect, we propose allo-HSCT in an upfront setting.…”

Human T-cell leukemia virus-associated malignancy

“…This study revealed several factors that significantly lowered survival rates: age of patient/recipient (>50), sex, status other than complete remission, and use of unrelated cord blood compared to HLA-matched related grafts. Another retrospective study recently reported a 3-year overall survival rate of 39.9% for patients treated with alloHSCT [78]. Unfortunately, in this study, the use of alloHSCT had limited success in chemorefractory ATL patients.…”

Outcome of allogeneic hematopoietic cell transplantation in patients with adult T‐cell leukemia

“…Patients who remained alive at the time of the last follow‐up were censored. The definition of a therapeutic response to chemotherapy was based on a previous report and its modification . Response to treatment was divided into four categories: CR, partial remission (PR), stable disease (SD), and progressive disease (PD).…”

“…There has been no randomized comparison of chemotherapy alone vs allo‐HSCT. Kawada et al performed a retrospective analysis of treatment outcome in ATL patients and showed improved 3‐year OS in allo‐HSCT recipients over those receiving chemotherapy alone. In a retrospective nationwide study, Fuji et al also recently reported better OS in transplanted patients compared with nontransplanted patients.…”