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

Abstract

Adult T‐cell leukemia/lymphoma (ATL) is an aggressive peripheral T‐cell neoplasm, and the outcome of patients with ATL after chemotherapy is poor. Allogeneic hematopoietic stem‐cell transplantation (allo‐HSCT) is a curative treatment modality for ATL, and four factors, namely, age > 50 years, male recipient, lack of complete remission at transplantation, and transplantation of cord blood, were previously shown to be associated with poor survival. We retrospectively analyzed the outcome of 21 patients with ATL who had undergone allo‐HSCT at our hospital during a 3‐year period. Of 21 patients, all had at least one of the above risk factors, and 18 had two or more. With a median follow‐up of 19.7 months for living patients, the 1‐ and 2‐year overall survival (OS) rates after transplantation were 34% and 27%, respectively. All relapse/progression events occurred within 1 year after allo‐HSCT, and the cumulative incidence of relapse/progression at 1 year after allo‐HSCT was 46.9%. The 100‐day and 1‐year nonrelapse mortality (NRM) rates were 19% and 42%, respectively. No significant difference in OS was observed between myeloablative and reduced‐intensity conditioning regimens. The 3‐year OS (27%) of ATL patients who received allo‐HSCT and who had at least one adverse factor was somewhat poorer than the 3‐year OS of 33% identified in a nationwide study of allo‐HSCT in ATL patients in Japan. The high relapse/progression and NRM rates are major problems to be solved to achieve better outcome.

Allogeneic Stem Cell Transplantation for Adult T-Cell Leukemia/Lymphoma—Romanian Experience

“…Romania is one of the regions with the highest prevalence of HTLV1 infection (5.33 at 10,000 donors in 2003-2008) [3]. Moreover, our group's analysis on ATLL cases showed a lower median age at diagnosis in aggressive type ATLL (42.5 years) [13] compared to Japanese [6,11] as well as European studies [12]. This might reflect an origin of infection in the 1980s in Romania, where other outbreaks occurred by horizontal transmission in that period, including an outbreak of HIV-1 [18].…”

“…The outcome of aggressive ATLL is poor in most patients not receiving allo-HSCT with 16-42% complete remission (CR) rate, followed by early relapses after a median progression-free survival time of 5-to 7-months and 4-year overall survival below 10% [1,5,8]. Several retrospective analyses of allo-HSCT in Japan and Europe reported long-term survival (at 3-years) in 27-45% of allo-HSCT recipients after chemotherapy but with significant associated morbidity and mortality [8][9][10][11][12]. As responses to intensive chemotherapy are not durable and the progressive disease has a poor outcome even after allo-HSCT, it is recommended that patients with aggressive ATLL should be referred as soon as possible to a transplantation center in order to receive up-front allo-HSCT, preferably from a HTLV-1 seronegative donor [1].…”

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.…”

Current state of CAR-T therapy for T-cell malignancies

“…They enrolled 4 T-ALL and 5 T-NHL patients. Three of these patients received CAR-T infusion at a dose of 1×10 7 /m², and the other six patients received 5×10 7 /m². Four to eight weeks later, four patients achieved an objective response, and three patients achieved a complete response.…”