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The outcome and characteristics of patients with relapsed adult T cell leukemia/lymphoma after allogeneic hematopoietic stem cell transplantation
Author(s) -
Kato Koji,
Uike Naokuni,
Wake Atsushi,
Yoshimitsu Makoto,
Tobai Tomomi,
Sawayama Yasushi,
Takatsuka Yoshifusa,
Fukuda Takahiro,
Uchida Naoyuki,
Eto Tetsuya,
Nakashima Yasuhiro,
Kondo Tadakazu,
Taguchi Jun,
Miyamoto Toshihiro,
Nakamae Hirohisa,
Ichinohe Tatsuo,
Kato Koji,
Suzuki Ritsuro,
Utsunomiya Atae
Publication year - 2019
Publication title -
hematological oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 44
eISSN - 1099-1069
pISSN - 0278-0232
DOI - 10.1002/hon.2558
Subject(s) - medicine , hazard ratio , hematopoietic stem cell transplantation , transplantation , oncology , lymphoma , donor lymphocyte infusion , leukemia , retrospective cohort study , confidence interval , gastroenterology
Treatment options for patients with adult T cell leukemia/lymphoma (ATLL) who have relapsed disease after allogeneic hematopoietic stem cell transplantation (allo‐HSCT) are limited. To clarify which patients with ATLL are likely to benefit from these treatment options and to define patient populations for novel treatments, we performed a nationwide retrospective analysis of 252 Japanese patients who had relapsed ATLL after allo‐HSCT. Some long‐term survivors remained after tapering and withdrawal of immunosuppressive agents. Thirty‐six patients who received donor lymphocyte infusion had a better overall survival (OS) in comparison to those who did not [hazard ratio (HR), 0.63; 95% confidence interval (CI), 0.43‐0.93; P = .02], suggesting the efficacy of a graft‐versus‐ATLL (GvATLL) effect even after relapse. Multivariate analysis demonstrated that skin lesions at initial relapse of ATLL were independently associated with higher OS (HR, 0.41; 95% CI, 0.22‐0.74; P = .003), indicating that the skin is a susceptible target organ of GvATLL. This study suggested that enhancement of a GvATLL effect is a potential therapeutic option for relapsed disease after allo‐HSCT. Further investigations of incorporation of immune‐based approaches with new molecular target drugs into the therapeutic options of patients with ATLL before and after transplantation are warranted.