Improved survival of patients with aggressive ATL by increased use of allo-HCT: a prospective observational study

Abstract

Aggressive adult T-cell leukemia/lymphoma (ATL) is a hematological malignancy that is difficult to treat with chemotherapy alone, and allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy. We conducted a multicenter, prospective, observational study to clarify the treatment outcomes of aggressive ATL in the current era. Between 2015 and 2018, 113 patients aged 70 years or younger with newly diagnosed aggressive ATL were enrolled. The median age at diagnosis was 61 years old. Treatment outcomes were compared with those of 1,792 ATL patients diagnosed between 2000 and 2013 in our previous retrospective study. The inclusion criteria were the same in both studies. The prospective cohort demonstrated better overall survival (OS) than the retrospective cohort (2-year OS, 45% versus 29%, respectively; P<0.001), with a much higher proportion of patients receiving allo-HCT (80% versus 34%, respectively; P<0.001) and a shorter interval from diagnosis to allo-HCT (median, 128 versus 170 days, respectively; P<0.001). Among the 90 patients who received allo-HCT (cord blood, n=30; HLA-haploidentical related donors, n=20; other related donors, n=14; other unrelated donors, n=26), the 2-year probabilities of OS, non-relapse mortality (NRM), and disease progression were 44%, 23%, and 46%, respectively. OS and NRM did not differ statistically according to donor type. Our results suggest that increased application of allo-HCT improved the survival of patients with aggressive ATL. The use of cord blood or HLA-haploidentical donors may be feasible for aggressive ATL when HLA-matched related donors are unavailable. This study was registered with the UMIN Clinical Trials Registry (UMIN 000017672).

Current and emerging therapeutic strategies in adult T-cell leukemia–lymphoma

“…Retrospective data of CBT indicated high TRM rates (10-46%) and poor prognosis [27][28][29][30]. However, a subsequent prospective observation study showed improved NRM and survival rates in patients receiving CBT, which did not differ from those of patients with related or unrelated donors [31]. Haplo-HSCT with post-transplant cyclophosphamide (PTCy) has improved transplantation outcomes in other hematologic malignancies.…”

Adult T-cell leukemia and lymphoma in French Guiana: a retrospective analysis with real-life data from 2009 to 2019

“… 11 Allogeneic stem cell transplantation is the only curative treatment. 12 But it is only accessible in high income countries, which are often distinct from the HTLV-1 endemic areas. 13 …”

A new paradigm for the management of ATL

“…10 From a comparable period in Japan the four-year OS is 16% for acute leukaemia and 19% for lymphoma 11 whilst Ito et al report a 45% two-year OS following allo-HCT in a prospective study. 12 More recent prospective data on the use of haploidentical transplant suggest significantly improved survival (73% two-year OS), albeit in small numbers. 13 Whilst these findings need further validation, they also make it difficult to be prescriptive about the benefits of mogamulizumab for all patients.…”