Pretransplantation Anti-CCR4 Antibody Mogamulizumab Against Adult T-Cell Leukemia/Lymphoma Is Associated With Significantly Increased Risks of Severe and Corticosteroid-Refractory Graft-Versus-Host Disease, Nonrelapse Mortality, and Overall Mortality

Abstract

Pretransplantation Mog was significantly associated with an increased risk of GVHD-related mortality, which supports the relevance of CCR4-expressing Tregs after allo-HSCT in humans. In clinical practice, Mog should be cautiously used for patients with ATLL who are eligible for allo-HSCT.

HLA-haploidentical hematopoietic stem cell transplantation with low-dose thymoglobulin GVHD prophylaxis for an adult T cell leukemia/lymphoma patient treated with pretransplant mogamulizumab

“…Pretransplant Mog significantly improved the disease status before haplo-PBSCT. Moreover, a recent nationwide study of ATLL patients with pretransplant Mog in Japan showed that pretransplant Mog with intervals of <50 days to allo-HSCT was associated with increased risk of GVHD-related mortality [6]. In our case, the interval between pretransplant Mog and haplo-PBSCT was 49 days.…”

“…In our case, the interval between pretransplant Mog and haplo-PBSCT was 49 days. The nationwide study also pointed out the possibility that in vivo effector T cell depletion with anti-thymocyte globulin contributes to the reduction of severe aGVHD in ATLL patients with pretransplant Mog [6]. To our knowledge, our case is the first report of successful prevention of aGVHD with low-dose thymoglobulin in haplo-PBSCT following pretransplant Mog.…”

“…Anti-CCR4 monoclonal antibody mogamulizumab (Mog) is the first immunotherapeutic agent targeting ATLL. Since CCR4 is expressed on regulatory T cells (Treg), there is growing concern regarding increased risk of severe and refractory acute graft-versus-host disease (aGVHD) in ATLL patients treated with Mog before allo-HSCT (pretransplant Mog) [3–6]. …”

Treatment advances and prognosis for patients with adult T-cell leukemia-lymphoma

“…The use of mogamulizumab before allo-HSCT correlated with an increased risk of graft-versushost disease (GVHD)-related mortality. 24 Further studies are needed in order to clarify appropriate settings and patient populations that would benefit from treatments with mogamulizumab.…”

Friend or foe? Mogamulizumab in allogeneic hematopoietic stem cell transplantation for adult T-cell leukemia/lymphoma

“…However, these studies were rather small to conduct multivariate analyses to adjust for the other risk factors of acute GVHD and other clinical events. Our group recently performed a retrospective analysis using a database of a nationwide survey of aggressive ATL (12). In this study, 82 patients out of 996 allo-HSCT recipients received moga before allo-HSCT.…”