Trial of long-term leukapheresis in the treatment of adult T-cell leukemia.

It is well known that adult T-cell leukemia (ATL) is usually refractory to chemotherapy, acute or subacute in clinical course and is accompanied by lethal infections, suggesting a deficiency in cellular immunity. Chemotherapy makes the deficiency in cellular immunity worse, and this is followed by lethal infections. Therefore, a patient with ATL underwent leukapheresis on an IBM 2997 cell separator. A total of 22.3 x 10(11) leukemic T cells was removed. Removal of a large number of leukemic T cells was not associated with improvements in clinical symptoms except for skin eruption, but was not complicated by lethal infections. The peripheral leukocyte count after the 14th procedure began to increase over the prepheresis levels. In the course of frequent leukapheresis, leukemic meningitis occurred. Intrathecal injections of a small dose of antileukemic agents resulted in a rapid reduction of the leukemic T cell count and improvements in clinical symptoms. However, the patient died from cryptococcal sepsis. The survival time was 10 months from clinical onset, 9 months from diagnosis, 9 months from leukapheresis and 5 months from chemotherapy. From this experience, it appears that long-term repeated leukapheresis can decrease lethal infections and extend the survival time.