Allogeneic hematopoietic stem cell transplantation for ATL with central nervous system involvement: The Nagasaki Transplant Group experience

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is regarded as a curative option for aggressive adult T cell leukemia-lymphoma (ATL). However, the efficacy and safety of allo-HSCT for ATL with central nervous system (CNS) involvement, which is highly resistant to chemotherapy, remain controversial. We analyzed 10 ATL patients with CNS involvement who received allo-HSCT at three institutions in Nagasaki prefecture between 2000 and 2007. The 3-year overall survival rate was 40%, and the median observation time of the four surviving patients was 1532 days (range 945-2212 days). Two of four surviving patients received highly intensive local treatment for the CNS; one with 26 intrathecal injections of antineoplastic agents, and the other with whole cerebrospinal irradiation before transplantation. However, the other two patients received conventional or reduced-intensity conditioning with standard intrathecal chemotherapy. Three of the four surviving patients experienced chronic GVHD, and two of three patients with grade 3 or 4 acute GVHD were free from CNS relapse. From these data, it seems that both intensive local treatment for CNS disease and systemic GVHD contributed to the long-term control of CNS involvement. Although our data suggest that allo-HSCT is a therapeutic option for ATL with CNS disease, high transplant-related mortality (six cases) indicates the need for further studies to develop more effective procedures for CNS disease, and to reduce transplant-related morbidity.

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

“…[5][6][7][8][9][10] In Japan, allogeneic hematopoietic stem cell transplantation (allo-SCT) has been explored as an alternative treatment that can provide long-term remission 11,12 ; overall survival (OS) at 3 years has been reported to be approximately 33%-45% in these patients. [13][14][15][16][17][18][19][20] However, the relapse rate after allo-SCT is approximately 40% 13 and relapsed patients have a very poor prognosis. Treatment options include withdrawal of immune suppressants (IS), chemotherapy, local radiation therapy, lymphocyte infusions (DLIs) from the original donor, and second allo-SCT, but there are limited data describing the outcome of each treatment.…”

“…Treatment options include withdrawal of immune suppressants (IS), chemotherapy, local radiation therapy, lymphocyte infusions (DLIs) from the original donor, and second allo-SCT, but there are limited data describing the outcome of each treatment. 12,17,19,21,22 It has been shown that the graft-versus-ATL (GVATL) effect plays an important role in the prevention of relapse 13,19,21,23,24 and therapy that could induce the GVATL reaction may improve postrelapse outcome. DLI, a therapy that would induce a GVL reaction, has gained a prominent role in the management of leukemia patients who relapse after allo-SCT.…”

Cord Blood Transplantation Provided Long-term Remission in a Case of Adult T-cell Leukemia-lymphoma (ATL) with Myelofibrosis

“…Allogeneic hematopoietic stem cell transplantation has been increasingly performed as an important therapeutic option for ATL because it may provide long-term remission by the graft-versus-ATL effect (8)(9)(10)(11)(12)(13). However, this approach is accompanied with a high risk of transplantation-related mortality (8,14).…”

Characteristic patterns of relapse after allogeneic hematopoietic SCT for adult T-cell leukemia–lymphoma: a comparative study of recurrent lesions after transplantation and chemotherapy by the Nagasaki Transplant Group

“…3,4 Allogeneic hematopoietic SCT (allo-SCT) for patients with aggressive ATL (acute, lymphoma and the unfavorable chronic type) is considered to be a therapeutic option that can provide apparent durable remission along with graft-vs-ATL effects. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, both the relapse rate and TRM after allo-SCT were previously shown to be high, and are urgent issues that need to be addressed. 9,19,20 Previous studies, including ours, raised the possibility that patients with local relapse may achieve long-term remission by local cytoreductive therapy alone, and that those with skin recurrence (i.e.…”