Treatment of relapsed adult T-cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation: the Nagasaki Transplant Group experience

• Published in: Blood Vol. 121; no. 1; pp. 219 - 225
• Main Authors: Itonaga, Hidehiro, Tsushima, Hideki, Taguchi, Jun, Fukushima, Takuya, Taniguchi, Hiroaki, Sato, Shinya, Ando, Koji, Sawayama, Yasushi, Matsuo, Emi, Yamasaki, Reishi, Onimaru, Yasuyuki, Imanishi, Daisuke, Imaizumi, Yoshitaka, Yoshida, Shinichiro, Hata, Tomoko, Moriuchi, Yukiyoshi, Uike, Naokuni, Miyazaki, Yasushi
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 03.01.2013; Americain Society of Hematology
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Disease Progression; Disease-Free Survival; Female; Graft vs Leukemia Effect; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation; Human viral diseases; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Japan; Kaplan-Meier Estimate; Leukemia-Lymphoma, Adult T-Cell - drug therapy; Leukemia-Lymphoma, Adult T-Cell - surgery; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukemic Infiltration; Lymphocyte Transfusion; Male; Medical sciences; Middle Aged; Multicenter Studies as Topic - statistics & numerical data; Remission Induction; Retrospective Studies; Salvage Therapy; Skin - pathology; Transplantation, Homologous; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Japan; Relapse; Hematology; Stem cell; Adult T cell leukemia lymphoma; Hematopoietic cell; Homograft; Malignant hemopathy; Non Hodgkin lymphoma; Infection; Treatment; Allogeneic hematopoietic stem cell transplantation; Lymphoproliferative syndrome; Viral disease; Graft; Cancer
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2012-07-444372

Adult T-cell leukemia/lymphoma (ATL) relapse is a serious therapeutic challenge after allogeneic hematopoietic stem cell transplantation (allo-SCT). In the present study, we retrospectively analyzed 35 patients who experienced progression of or relapsed persistent ATL after a first allo-SCT at 3 institutions in Nagasaki prefecture (Japan) between 1997 and 2010. Twenty-nine patients were treated by the withdrawal of immune suppressants as the initial intervention, which resulted in complete remission (CR) in 2 patients. As the second intervention, 9 patients went on to receive a combination of donor lymphocyte infusion and cytoreductive therapy and CR was achieved in 4 patients. Of 6 patients who had already had their immune suppressants discontinued before the relapse, 3 patients with local recurrence received local cytoreductive therapy as the initial treatment, which resulted in CR for more than 19 months. Donor lymphocyte infusion–induced remissions of ATL were durable, with 3 cases of long-term remission of more than 3 years and, interestingly, the emergence or progression of chronic GVHD was observed in all of these cases. For all 35 patients, overall survival after relapse was 19.3% at 3 years. The results of the present study suggest that induction of a graft-versus-ATL effect may be crucial to obtaining durable remission for ATL patients with relapse or progression after allo-SCT. •ATL patients who relapsed after allogeneic HSCT have a very high mortality rate and present a serious therapeutic challenge.•No large study exists that assesses the role of salvage therapies for relapsed ATL after HSCT; this is the first report summarizing the outcome.