A retrospective analysis of allogeneic hematopoietic stem cell transplantation for adult T cell leukemia/lymphoma (ATL): clinical impact of graft-versus-leukemia/lymphoma effect

Biol Blood Marrow Transplant. 2008 Jul;14(7):817-23. doi: 10.1016/j.bbmt.2008.04.014.

Abstract

Adult T cell leukemia/lymphoma (ATL) is a highly aggressive T cell malignancy, and has a poor prognosis. Recently, allogeneic-hematopoietic stem cell transplantation (allo-HSCT) has been suggested to improve the outcome. We retrospectively analyzed 15 patients with ATL who had received allo-HSCT in 2 institutions in Hokkaido, Japan. The median age of the patients was 57 years. The estimated 3-year overall survival (OS) and progression-free survival (PFS) rates were 73.3% and 66.7%, respectively. Calcineurin inhibitor dosage was reduced and administration was discontinued abruptly in 6 of the 15 patients for disease control; as a result, 4 (66.7%) of the 6 patients achieved complete response (CR) or partial response. Therefore, a graft-versus-leukemia/lymphoma (GVL) effect might be induced by discontinuation of immunosuppression. Thirteen of the 15 patients were followed up by monitoring HTLV-1 proviral DNA levels. In 10 of the 11 patients with positive HTLV-1 proviral DNA before allo-HSCT, HTLV-1 proviral DNA became undetectable at least once after allo-HSCT, and only 1 of the 5 patients in whom HTLV-1 proviral DNA became detectable after allo-HSCT relapsed. Compared to the results of past studies, these results show that allo-HSCT greatly improved the prognosis of ATL and suggest a contribution of the induction of a GVL effect.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Graft vs Leukemia Effect*
  • HTLV-I Infections / blood
  • HTLV-I Infections / therapy
  • Hematopoietic Stem Cell Transplantation / methods*
  • Humans
  • Kaplan-Meier Estimate
  • Leukemia-Lymphoma, Adult T-Cell / therapy*
  • Male
  • Middle Aged
  • Remission Induction
  • Retrospective Studies
  • Transplantation, Homologous
  • Viral Load