Use of Zidovudine and Interferon Alfa With Chemotherapy Improves Survival in Both Acute and Lymphoma Subtypes of Adult T-Cell Leukemia/Lymphoma

• Published in: Journal of clinical oncology Vol. 29; no. 35; pp. 4696 - 4701
• Main Authors: HODSON, Andrew, CRICHTON, Siobhan, FIELDS, Paul A, MONTOTO, Silvia, MIR, Naheed, MATUTES, Estella, CWYNARSKI, Kate, KUMARAN, Thurai, ARDESHNA, KiritM, PAGLIUCA, Antonio, TAYLOR, Graham P
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 10.12.2011
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Female; Hematologic and hematopoietic diseases; Humans; Interferon-alpha - administration & dosage; Leukemia-Lymphoma, Adult T-Cell - drug therapy; Leukemia-Lymphoma, Adult T-Cell - pathology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Middle Aged; Retrospective Studies; Survival Analysis; Tumors; Young Adult; Zidovudine - administration & dosage; RNA-directed DNA polymerase; Alpha interferon; Adult T cell leukemia lymphoma; Cancerology; Reverse transcriptase inhibitor; Lymphoproliferative syndrome; Nucleoside analog; Antiviral; Pyrimidine nucleoside; Enzyme; Transferases; Acute; Enzyme inhibitor; Malignant hemopathy; Lymphoid neoplasm; Non Hodgkin lymphoma; Survival; Infection; Nucleotidyltransferases; Chemotherapy; Treatment; Dideoxynucleoside; Viral disease; Subtype; Zidovudine; Interferon alfa; Cancer
• DOI: 10.1200/JCO.2011.35.5578
• ISSN: 0732-183X

Adult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-α) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis. We report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-α on treatment response and survival was assessed. The overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-α). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-α at any time prolonged survival in acute (P < .001) and lymphoma ATLL (P < .001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone. These data support the use of low-dose ZDV/IFN-α with chemotherapy in first-line treatment of acute and lymphoma ATLL.