Successful treatment of HTLV‐1‐associated acute adult T‐cell leukaemia lymphoma by allogeneic bone marrow transplantation

Abstract

HTLV-1-associated acute adult T-cell leukaemia-lymphoma (ATL) is a highly aggressive malignant disorder with a median survival of 6 months or less. We describe an Afro-Caribbean female with very poor prognosis ATL who underwent chemotherapy with a 4 d infusion schedule of cyclophosphamide, doxorubicin and etoposide, followed by successful allogeneic bone marrow transplantation (BMT) from her HTLV-1-negative histocompatible sister. The patient remains in complete remission 23 months after BMT and has 100% donor haemopoiesis with no evidence of HTLV-1 infection on PCR testing. We suggest that allo-BMT can prolong disease free survival or may even be curative in HTLV patients.

Reduced Frequency, Diversity, and Function of Human T Cell Leukemia Virus Type 1-Specific CD8+ T Cell in Adult T Cell Leukemia Patients

“…Although there has been recent progress in chemotherapy for ATL, with the LSG15 protocol showing an overall 5-year survival rate of 17.5% (6), the prognosis of ATL is still poor. The recent report of successful, sustained complete remission of ATL by hemopoietic stem cell transplantation led to the hypothesis that immunocompetency reconstructed by stem cell transplantation may regenerate cytotoxic immune effectors against HTLV-1-tranformed T cell and related tumor Ags, and then induce a graft-vs-leukemia reaction in ATL patients (7,8).…”

Human T cell lymphotropic virus-associated leukemia/lymphoma

“…The role of allogenic SCT for ATLL remains unclear [46][47][48][49][50][51][52]. In a recent study of 16 patients over the age of 50 with ATLL who underwent allogeneic SCT, a reduced-intensity conditioning regimen with fludarabine, busulfan, and rabbit antithymocyte globulin was well tolerated [53].…”

Human T-Cell Lymphotropic Virus (HTLV-1) and Adult T-Cell Leukemia

“…As described above, most ATL cells express CCR4 antigen on their surfaces, and a humanized antibody against CCR4 is being developed as an anti-ATL agent (Ishida et al 2004). Advances in the treatment of ATL were brought about by allogeneic bone marrow or stem cell transplantation (Borg et al 1996;Yamada et al 2001). Absence of graft-versus-host disease (GVHD) was linked with relapse of ATL, suggesting that GVHD or graft-versus-ATL may be implicated in the clinical effects of allogeneic stem cell transplantation (Borg et al 1996).…”

“…Advances in the treatment of ATL were brought about by allogeneic bone marrow or stem cell transplantation (Borg et al 1996;Yamada et al 2001). Absence of graft-versus-host disease (GVHD) was linked with relapse of ATL, suggesting that GVHD or graft-versus-ATL may be implicated in the clinical effects of allogeneic stem cell transplantation (Borg et al 1996). Furthermore, 16 patients with ATL, who were over 50 years of age, were treated with allogeneic stem cell transplantation with reduced conditioning intensity (RIST) from HLA-matched sibling donors (Okamura et al 2005).…”