National Centre for Human Retrovirology, St Mary’s Hospital, Imperial College Healthcare National Health Service Trust, United Kingdom.
J Clin Oncol. 2011 Dec 10;29(35):4696-701. doi: 10.1200/JCO.2011.35.5578. Epub 2011 Oct 31.
Adult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-α) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis.
We report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-α on treatment response and survival was assessed.
The overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-α). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-α at any time prolonged survival in acute (P < .001) and lymphoma ATLL (P < .001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone.
These data support the use of low-dose ZDV/IFN-α with chemotherapy in first-line treatment of acute and lymphoma ATLL.
成人 T 细胞白血病/淋巴瘤（ATLL）是一种与人类 T 淋巴细胞病毒 1 感染相关的成熟（胸腺后）T 细胞淋巴瘤。侵袭性亚型的生存仍然较差，且治疗耐药性常见。在一些小型研究中，齐多夫定（ZDV）和干扰素-α（IFN-α）的使用与提高反应率有关，最近的一项荟萃分析表明，在白血病性 ATLL 亚型中，ZDV/IFN-α 可延长总生存时间。
我们报告了 73 例在英国于 1999 年至 2009 年诊断和治疗的侵袭性 ATLL（急性 ATLL，29 例；淋巴瘤性 ATLL，44 例）患者的临床病理特征、治疗和结局。评估了 ZDV/IFN-α 对治疗反应和生存的影响。
单独化疗的总体缓解率为 49%，而联合一线治疗（化疗联合同步/序贯 ZDV/IFN-α）的总体缓解率为 81%。中位总生存期（OS）为 9 个月：急性 ATLL 为 7.5 个月，淋巴瘤性 ATLL 为 10 个月。在任何时间使用 ZDV/IFN-α均可延长急性（P <.001）和淋巴瘤性 ATLL（P <.001）的生存时间，并且是侵袭性 ATLL 降低死亡风险的唯一因素（风险比，0.23；95%CI，0.09 至 0.60；P =.002）。与单独化疗相比，联合一线治疗可延长急性（P =.0081）和淋巴瘤性 ATLL（P =.001）的中位 OS。
这些数据支持在急性和淋巴瘤性 ATLL 的一线治疗中使用低剂量 ZDV/IFN-α 联合化疗。
