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

Shiratori, S.; Yasumoto, A.; Tanaka, J.; Shigematsu, A.; Yamamoto, S.; Nishio, M.; Hashino, S.; Morita, R.; Takahata, M.; Onozawa, M.; Kahata, K.; Kondo, T.; Ota, S.; Wakasa, K.; Sugita, J.; Koike, T.; Asaka, M.; Kasai, M.; Imamura, M.

Biology of Blood and Marrow Transplantation Journal of the American Society for Blood and Marrow Transplantation 14(7): 817-823


ISSN/ISBN: 1083-8791
PMID: 18541202
DOI: 10.1016/j.bbmt.2008.04.014
Accession: 051239104

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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.