Fukushima T, Miyazaki Y, Honda S, Kawano F, Moriuchi Y, Masuda M, Tanosaki R, Utsunomiya A, Uike N, Yoshida S, Okamura J, Tomonaga M
Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Leukemia. 2005 May;19(5):829-34. doi: 10.1038/sj.leu.2403682.
Adult T-cell leukemia/lymphoma (ATLL) is a distinct peripheral T-cell neoplasm that is highly resistant to chemotherapy. Several groups, including ours, have reported encouraging results of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with ATLL. To confirm our previous report and to establish the basis for a phase II clinical study, we analyzed 40 allo-HSCT for acute and lymphoma types of ATLL in seven institutions in Japan between 1997 and 2002. All evaluable cases entered complete remission (CR) after allo-HSCT and the median survival time was 9.6 months for all patients. The estimated 3-year overall and relapse-free survival, and disease relapse were 45.3, 33.8 and 39.3%, respectively. Among 10 cases with ATLL relapse, five cases achieved CR again: three by the reduction or cessation of immunosuppressive agents, which suggested a graft-versus-ATLL (GvATLL) effect. However, univariate or multivariate analysis did not show any benefit of graft-versus-host disease (GVHD) on the prevention of relapse. These results suggested that allo-HSCT was effective for some patients with aggressive ATLL, and that the GvATLL effect could be achieved even without GVHD. A new phase II trial to test the efficacy of allo-HSCT for ATLL is warranted.
成人T细胞白血病/淋巴瘤（ATLL）是一种独特的外周T细胞肿瘤，对化疗具有高度抗性。包括我们在内的几个研究小组都报告了异基因造血干细胞移植（allo-HSCT）治疗ATLL患者取得的令人鼓舞的结果。为了证实我们之前的报告并为II期临床研究奠定基础，我们分析了1997年至2002年间日本七个机构中40例接受allo-HSCT治疗的急性和淋巴瘤型ATLL患者。所有可评估病例在allo-HSCT后均进入完全缓解（CR）状态，所有患者的中位生存时间为9.6个月。估计3年总生存率、无复发生存率和疾病复发率分别为45.3%、33.8%和39.3%。在10例ATLL复发患者中，有5例再次实现CR：3例通过减少或停用免疫抑制剂实现，这提示了移植物抗ATLL（GvATLL）效应。然而，单因素或多因素分析均未显示移植物抗宿主病（GVHD）对预防复发有任何益处。这些结果表明，allo-HSCT对一些侵袭性ATLL患者有效，并且即使没有GVHD也可实现GvATLL效应。有必要开展一项新的II期试验来测试allo-HSCT治疗ATLL的疗效。
