Background: The urgent need for the treatment of ATLL has highlighted in 18th-International Conference on Human Retrovirology-HTLV-1 (Tokyo, 2017). Therefore, in this study the median survival times (MST) of routine therapies for ATLL were evaluated in context of laboratory tests . Methods: In a perspective-retrospective cohort study, the efficiencies of therapy regimens, including interferon-alfa and zidovudine (IFN/ZDV), cyclophosphamide, vincristine, doxorubicin, dexamethasone (hyper-CVAD), lenalidomide/ZDV, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) were evaluated in 67 acute ATLL patients. The demographic, clinical, MST, and routine and molecular laboratory data were then collected and analyzed . Results: The MST for acute and lymphoma subjects was 5 and 11 months, respectively, including 5 months (95% CI 3.378 6.622) for IFN/ZDV, 5 months (95% CI 2.067.94) for CVAD, 3months (95% CI 0.009.86) for lenalidomide/ZDV and 11 months (95%CI 8.45913.54) for CHOP regimen. Importantly, patients who received IFN/ZDV and hyper-CVAD therapy, had a better OS (HR, 0.663; 95%CI, 0.540 to 0.814; P=0.0001), compared with the lenalidomide /ZDV alone. The MST for subjects with hypercalcemia was 5 months, and for patients with normal calcium level was 9 months (p=0.017). Conclusions: High expressions of BIM and CERB were more frequent in lymphomatous type, and considering these factors, platelet counts and HTLV-1-proviral load (PVL) might be predictive factors for differentiating acute and chronic types. Low MST was observed in acute and lymphomatous ATLL, even in the combinational chemo-therapeutic regimens. Therefore, it seems that ATLL treatment should be personalized according to the virus-host interactions on survival signaling pathways, the platelet count and calcium level.