Successful treatment of post-transplant relapsed adult T cell leukemia after cord blood transplantation with low-dose, short-term lenalidomide

Ando, Toshihiko; Kojima, Kensuke; Sano, Haruhiko; Kidoguchi, Keisuke; Kusaba, Koji; Yoshimura, Masataka; Yokoo, Masako; Kubota, Yasushi; Nakamura, Hideaki; Takase, Yukinori; Aishima, Shinichi; Kimura, Shinya

doi:10.1080/10428194.2018.1427859

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…Further, a study showed that half of the MM patients who relapsed after allo-HCT could be controlled by lenalidomide administration (Bensinger et al, 2014). Only one patient with ATL was reported to have been successfully treated by a small dosage of lenalidomide for relapse after allo-HCT (Ando et al, 2018). The appropriate use of lenalidomide could be useful for patients with ATL who relapsed after allo-HCT or who planned to undergo allo-HCT.…”

Section: New Strategy For Atl By Using Transplantmentioning

confidence: 99%

Progress in Allogeneic Hematopoietic Cell Transplantation in Adult T-Cell Leukemia-Lymphoma

Utsunomiya

2019

Front. Microbiol.

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The prognosis of aggressive adult T-cell leukemia-lymphoma (ATL) remains poor because of frequent infections and drug resistance. Dose-intensified chemotherapy followed by autologous stem cell transplantation failed to improve the prognosis of patients with ATL; however, we first revealed that allogeneic hematopoietic cell transplantation (allo-HCT) might improve their prognosis. We showed that reducedintensity stem cell transplantation using peripheral blood was feasible for elderly patients. Further, the prognosis of patients in remission, who receive cord blood transplantation, has been recently improved and is equivalent to that of patients who receive transplants from other stem cell sources. As for the timing of HCT, the patients who underwent transplantation early showed better outcomes than those who underwent transplantation late. Based on the analysis of patients with aggressive ATL, including those who received transplants, we identified five prognostic factors for poor outcomes: acute-type ATL, poor performance status, high soluble interleukin-2 receptor levels, hypercalcemia, and high C-reactive protein level. Next, we developed a new prognostic index: the modified ATL-PI. The overall survival (OS) rates were significantly higher in patients who underwent allo-HCT than those who did not in the intermediate and high-risk groups stratified using the modified ATL-PI. Two new anti-cancer agents, mogamulizumab and lenalidomide, were recently approved for ATL patients in Japan. They are expected to induce longer survival in ATL patients when administered along with transplantation. However, a retrospective analysis that the risk of severe, acute, and corticosteroid-refractory graft-versus-host disease was higher in patients who received mogamulizumab before allo-HCT, and that mogamulizumab might increase the transplant-related mortality (TRM) rates and decrease the OS rates compared to those of patients who did not receive mogamulizumab. However, our recent study showed that administration of mogamulizumab before allo-HCT tended to improve the survival of patients with ATL. In conclusion, allo-HCT procedures for patients with aggressive Frontiers in Microbiology | www.frontiersin.org October 2019 | Volume 10 | Article 2235 Utsunomiya Allo-HCT in ATL ATL have considerably progressed and have helped improve the prognosis of these patients; however, many concerns still remain to be resolved. Further development of allo-HCT by using new molecular targeting agents is required for the improvement of cure rates in patients with ATL.

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Section: New Strategy For Atl By Using Transplantmentioning

confidence: 99%

Progress in Allogeneic Hematopoietic Cell Transplantation in Adult T-Cell Leukemia-Lymphoma

Utsunomiya

2019

Front. Microbiol.

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“…Because lymphocyte subset analysis was not performed when 10 mg of lenalidomide was administered, no clear conclusion could be drawn. As shown in Table 1, Ando et al and Morishige et al reported GVHD with a graft-versus-ATL reaction following lenalidomide treatment 5,6 . Sakamoto et al also reported that three of four patients developed GVHD and that two patients achieved complete remission 7 .…”

Section: Discussionmentioning

confidence: 97%

“…In patients with relapsed myeloma after allo-HCT, lenalidomide therapy at 10 mg day may not be feasible because of the induction of severe GVHD 4 . However, another study showed that lenalidomide therapy at 10 mg day may be safely administered with acceptable tolerability 5 . In our case, we used lenalidomide treatment at 10 mg day, referring the starting dose of the treatment for posttransplant relapsed ATL Table 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Lenalidomide induces antitumor immune responses mediated by T and NK cells 4 . Although lenalidomide has been approved for patients with ATL in Japan, clinical information on its efficacy and safety in post-transplant relapsed ATL is limited [5][6][7] . There have been only three reports of successful treatment.…”

Section: Introductionmentioning

confidence: 99%

“…There have been only three reports of successful treatment. Ando et al reported a patient who was successfully treated with lenalidomide 5 . Morishige et al reported a patient who was successfully treated with sequential mogamulizumab and lenalidomide 6 .…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment with lenalidomide for relapsed adult T-cell leukemia/lymphoma after cord blood cell transplantation

Fujimaki

Hibino

Kishimoto

et al. 2021

BCT

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The prognosis for relapsed adult T-cell leukemia／lymphoma(ATL)after allogeneic hematopoietic stem cell transplantation is poor. Here, we report the case of a 67-year-old man who survived for 26 months after treatment with lenalidomide for post-transplant relapsed ATL. He underwent induction therapy with two cycles of modified VCAP-AMP-VECP and achieved complete remission. He received cord blood cell transplantation following a reduced-intensity conditioning regimen. Seven months after transplantation, swelling of the systemic lymph nodes appeared, and relapsed ATL was diagnosed based on a biopsy of the cervical lymph node. Treatment with 10 mg of lenalidomide induced partial remission. At 18 months after transplantation, skin tumors were successfully treated by increasing the dose of lenalidomide to 15 mg with the emergence of skin graft-versus-host disease. Although he died from ATL at 34 months after transplantation, systemic relapsed lesions were controlled by treatment with lenalidomide for 26 months. Our case suggests that lenalidomide is well tolerated and is an effective option for the treatment of post-transplant relapsed ATL.

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Lenalidomide treatment for recurrent adult T‐cell leukemia/lymphoma after allogeneic hematopoietic cell transplantation

Tanaka

Inamoto

Ito

et al. 2022

Hematological Oncology

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Patients with recurrent adult T‐cell leukemia/lymphoma (ATL) after allogeneic hematopoietic cell transplantation (allo‐HCT) have a dismal prognosis. We retrospectively evaluated the safety and efficacy of lenalidomide (LEN) in 11 consecutive patients with recurrent ATL after allo‐HCT. The median time from allo‐HCT to ATL recurrence was 111 days (range, 20–1476), and that from allo‐HCT to the initiation of LEN was 162 days (range, 43–1560). The median initial daily dose of LEN was 10 mg (range, 5–25), and the median duration of LEN treatment was 37 days (range, 3–1078). Three patients (27%) achieved complete response and two (18%) achieved partial response (PR). The rates of complete or PR according to the involved site were 57% for skin and 50% for nodal or extranodal lesions. With a median follow‐up of 1033 days (range, 601–1465) among survivors, the 1‐year probability of overall survival (OS) after ATL recurrence was 55%. Grade ≥3 toxicities included cytopenia (n = 4), superficial vein thrombosis (n = 1), and deep vein thrombosis (n = 1). Graft‐versus‐host disease (GVHD) newly developed in five patients (45%) and worsened in four patients (36%). The median duration from the initiation of LEN to GVHD onset or worsening was 5 days (range, 1–9). GVHD was manageable in all patients. Seven patients received mogamulizumab (MOG) for recurrent ATL before LEN treatment. The overall response rates to LEN were 57% in patients who had previously received MOG and 25% in those who had not. The 1‐year probabilities of OS after recurrent ATL were 71% in patients who had previously received MOG and 25% in those who had not. Although cytopenia and GVHD are common among patients with recurrent ATL after allo‐HCT, LEN may improve survival. Administering MOG before LEN may augment treatment efficacy in the allo‐HCT population.

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Successful treatment of post-transplant relapsed adult T cell leukemia after cord blood transplantation with low-dose, short-term lenalidomide

Cited by 5 publications

References 15 publications

Progress in Allogeneic Hematopoietic Cell Transplantation in Adult T-Cell Leukemia-Lymphoma

Progress in Allogeneic Hematopoietic Cell Transplantation in Adult T-Cell Leukemia-Lymphoma

Successful treatment with lenalidomide for relapsed adult T-cell leukemia/lymphoma after cord blood cell transplantation

Lenalidomide treatment for recurrent adult T‐cell leukemia/lymphoma after allogeneic hematopoietic cell transplantation

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