Characteristic patterns of relapse after allogeneic hematopoietic SCT for adult T-cell leukemia–lymphoma: a comparative study of recurrent lesions after transplantation and chemotherapy by the Nagasaki Transplant Group

Abstract

Allogeneic hematopoietic SCT (allo-SCT) is a promising therapy that may provide long-term durable remission for adult T-cell leukemia-lymphoma (ATL) patients; however, the incidence of relapse associated with ATL remains high. To determine the clinical features of these patients at relapse, we retrospectively analyzed tumor lesions in 30 or 49 patients who relapsed following allo-SCT or chemotherapy (CHT), respectively, at three institutions in Nagasaki prefecture between 1997 and 2011. A multivariate analysis revealed that the development of abnormal lymphocytes in the peripheral blood of patients at relapse was less frequent after allo-SCT than after CHT (P o 0.001). Furthermore, relapse with a new lesion only in the absence of the primary lesion was more frequent in allo-SCT (P = 0.014). Lesions were more frequently observed in the central nervous systems of patients who relapsed with new lesions only (P = 0.005). Thus, the clinical manifestation of relapsed ATL was slightly complex, especially in post-transplant patients. Our results emphasized the need to develop adoptive modalities for early and accurate diagnoses of relapsed ATL.

Clinical Features and Treatment Outcomes of Hematopoietic Stem Cell Transplantation During 2006-2016 at a Single Institution in Miyazaki Prefecture

“…14,15 In the discussion, we have considered and discussed why we did not provide allo-HSCT at the most appropriate timing antibody(inotuzumab) , 18 blinatumomab, 19 and CD19-CAR therapy； 20 those for AML, such as azacytidine(AZA) 21 or FMS-like tyrosine kinase 3(FLT 3)inhibitors； 22 and those for CML, such as tyrosine kinase inhibitors(TKIs) 23 Miyazaki prefecture, the OS of 40% after allo-HSCT treatment in 10 ATL cases was consistent with the findings of previous nationwide study [29][30][31] and previous endemic area reports from the Kyushu region in Japan. [32][33][34][35] Since the major cause of death after allo-HSCT was ATL relapse(6⊘6) , newer therapeutic agents such as C-C chemokine receptor type 4 (CCR4) a n t i b o d y a n d l e n a l i d o m i d e m a y b e n ove l t r e a t m e n t options. 36,37 In the present study, mogamulizumab was effective for the treatment of ATL in PB but was not effective for lymph nodes (LNS) lesions in ATL.…”

Treatment with mogamulizumab or lenalidomide for relapsed adult T‐cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: The Nagasaki transplant group experience

“…The involved lesion was defined as previously reported 40,41 ; peripheral blood involvement was considered present when more than 5% of abnormal lymphocytes were detected by morphologically. 5,6,[25][26][27][28][29] The involvement of lymph nodes and extranodal lesions was based on confirmation by pathological findings.…”

Cord Blood Transplantation Provided Long-term Remission in a Case of Adult T-cell Leukemia-lymphoma (ATL) with Myelofibrosis

“…One of the characteristic features of adult T-cell leukemialymphoma (ATL) is its frequent multi-organ involvement (1,2). The clinical subtype of ATL is classified according to laboratory findings and the location of the tumor lesion (1).…”