Transplantation for Aggressive Adult T-Cell Leukemia/Lymphoma (ATL)
Adult T-cell leukemia-lymphoma (ATL) is an intractable disease, even with various chemotherapeutic agents. Curative treatment has been achieved for some ATL patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Transplant-related mortality (TRM) caused by myeloablative conditioning is higher than that with reduced-intensity conditioning, but the relapse rate is lower. The outcomes of ATL patients who received a transplant while in complete remission (CR) are better than those of patients in non-CR, or than patients transplanted from HLA-mismatched donors. The outcomes of ATL patients who underwent cord blood transplantation (CBT) were previously reported to be poor, but more recent outcomes are improved. The cessation of immunosuppressants and/or donor lymphocyte infusion induced another remission in some relapsed ATL patients after allo-HSCT; these phenomena were thought to be graft-versus-ATL effects. Donor cell-derived ATL has been reported in two patients, and special attention should be paid to this complication. The establishment of allo-HSCT with low TRM combined with immunotherapy or molecular targeting therapy should improve the cure rate of ATL patients in the near future.
KeywordsAdult T-cell leukemia-lymphoma (ATL) Human T-cell leukemia virus type I (HTLV-1) Hematopoietic stem cell transplantation Graft-versus-ATL effect Donor cell-derived ATL
This work was supported in part by the Practical Research for Innovative Cancer Control from Japan Agency for Medical Research and Development, AMED.
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