Treatment of Patients with Adult T Cell Leukemia/Lymphoma with Cord Blood Transplantation: A Japanese Nationwide Retrospective Survey

Abstract

Allogeneic bone marrow and peripheral blood stem cell transplantations are curative treatment modalities for adult T cell leukemia/lymphoma (ATLL) because of the intrinsic graft-versus-ATLL effect. However, limited information is available regarding whether cord blood transplantation (CBT) induces a curative graft-versus-ATLL effect against aggressive ATLL. To evaluate the effect of CBT against ATLL, we retrospectively analyzed data from 175 patients with ATLL who initially underwent single-unit CBT. The 2-year overall survival (OS) rate was 20.6% (95% confidence interval [CI], 13.8% to 27.4%). A multivariate analysis revealed that the development of graft-versus-host disease (GVHD) was a favorable prognostic factor for OS (hazard ratio, .10; 95% CI, .01 to .94; P = .044). Furthermore, the 2-year OS (42.7%; 95% CI, 28.1% to 56.6%) of patients with grade 1 to 2 acute GVHD was higher than that of patients without acute GVHD (24.2%; 95% CI, 11.2% to 39.8%; P = .048). However, the cumulative incidence of treatment-related mortality (TRM) was high (46.1%; 95% CI, 38.2% to 53.7%), and early death was particularly problematic. In conclusion, CBT cures patients with ATLL partly through a graft-versus-ATLL effect. However, novel interventions will be required, particularly in the early phase, to reduce TRM and optimize GVHD.

Early application of related SCT might improve clinical outcome in adult T-cell leukemia/lymphoma

“…8,[16][17][18] Here, we demonstrated a survival advantage in ATLL patients who underwent early application of allo-HSCT from related donors. Furthermore, the results of CBT suggest that early application of allo-HSCT is promising for patients with ATLL, even those who lack an HLAmatched related donor.…”

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

“…However, this approach is accompanied with a high risk of transplantation-related mortality (8,14). In particular, a Japanese nationwide retrospective study of post-transplant patients with ATL reported a worse survival and higher treatment-related mortality following CBT than transplantation with HLA-matched related and unrelated bone marrow grafts (8,15,16). Moreover, MF is a persistent concern for engraftment delay and failure (17)(18)(19), although the successful engraftment of umbilical cord blood has been reported in allogeneic stem cell transplantation for the treatment of MF (20).…”

Treatment advances and prognosis for patients with adult T-cell leukemia-lymphoma

“…[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] Utsunomiya et al reported that allo-HSCT using myeloablative conditioning regimens (MAC) improved the outcome of ATL in 2001. 25 However, 4 out of 10 patients died of treatment-related mortality (TRM).…”

“…33,34 A Japanese nationwide retrospective survey reported the outcomes of 175 patients undergoing cord blood transplantation; OS at 2 years of 20.6% and TRM of 46%, respectively. 36 A prospective study to confirm the feasibility of unrelated cord blood transplantation has been completed in Japan.…”