Poor outcome of autologous stem cell transplantation for adult T cell leukemia/lymphoma: a case report and review of the literature

Abstract

Summary:A limited number of patients with adult T cell leukemia/lymphoma (ATL) who received autologous stem cell transplantation (ASCT) have been reported. We report here a case of fatal systemic Candida krusei infection in a female patient with ATL undergoing ASCT. All of the eight patients (including seven patients in the literature) with ATL who received ASCT developed relapse of ATL or death due to ASCT complication, irrespective of subtype or remission state of ATL, source or selection of SCT or conditioning regimen. At present, ASCT appears to provide little benefit for ATL in contrast to that for other types of aggressive non-Hodgkin's lymphoma. Keywords: ATL; HTLV-1; auto-BMT; auto-PBSCT Adult T cell leukemia/lymphoma (ATL) is a distinct clinicopathological entity, ie peripheral T lymphocytic malignancy caused by human T lymphotropic virus type 1 (HTLV-1). 1,2 Despite recent progress in combination chemotherapy for non-Hodgkin's lymphoma (NHL), acute and lymphoma types of ATL generally have a very poor prognosis with less than 1 year median survival because of infectious complications due to T cell immunodeficiency, multidrug resistance of ATL cells, large tumor burden with multi-organ failure and/or hypercalcemia. [3][4][5] At present, there is no standard therapy for ATL in contrast to CHOP therapy for aggressive NHL. 3,6 High-dose ablative therapy and autologous stem cell transplantation (ASCT) have been shown to be superior to non-ablative therapy in aggressive NHL as initial and salvage treatment. 7,8 High-dose therapy and ASCT has been reported in a limited number of patients with ATL, but most of those were in the form of an abstract. [9][10][11][12][13][14] We report here a case of fatal systemic Candida krusei (C. krusei) infection in a female patient with ATL undergoing ASCT, and review the reported ATL cases that received this therapy.

Hematopoietic SCT for adult T-cell leukemia/lymphoma: a review

“…Tsukasaki et al 22 reported a single case and found seven other reported cases in the literature. The outcome was grim with disease progression noticed within 10 months in all but one patient who had a remission lasting for 26 months.…”

“…Autologous transplantation was rarely attempted and did not yield success. 22 Allogeneic transplantation was first reported in 1987 by Sobue et al 23 After myeloablative conditioning, the recipient received BM graft from a matched sibling and went on to achieve CR only to die on day 205 due to interstitial pneumonitis. It was not until 1996 that Borg et al 5 reported the first successful allogeneic transplant.…”

Successful bone marrow transplantation from an unrelated donor in a patient with adult T cell leukemia

“…1,7 Although high-dose therapy and autologous stem cell transplantation have been shown to improve prognoses in other poor-risk aggressive lymphomas, outcomes for ATL remain poor due to high relapse rates and complications. 2 Utsunomiya et al 5 recently reported promising results for allo-SCT in patients with ATL. However, HLAmatched siblings are seldom available to these patients.…”

“…Intensified chemotherapy and/or autologous stem cell transplantation have not yet improved this prognosis. 1,2 Although some successful cases of allogeneic stem cell transplantation (allo-SCT) have been reported, [3][4][5] HLA-matched and HTLV-1 seronegative siblings are available to only a small number of patients.…”

Human T cell lymphotropic virus-associated leukemia/lymphoma

“…Autologous stem cell transplantation (SCT) is generally ineffective for leukemic or lymphomatous ATLL [45]. The role of allogenic SCT for ATLL remains unclear [46][47][48][49][50][51][52].…”