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Possibility of a risk‐adapted treatment strategy for untreated aggressive adult T‐cell leukaemia‐lymphoma ( ATL ) based on the ATL prognostic index: a supplementary analysis of the JCOG 9801
Author(s) -
Toyoda Kosuke,
Tsukasaki Kunihiro,
Machida Ryunosuke,
Kadota Tomohiro,
Fukushima Takuya,
Ishitsuka Kenji,
Maruyama Dai,
Nagai Hirokazu
Publication year - 2019
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15950
Subject(s) - vincristine , hazard ratio , prednisone , vindesine , medicine , gastroenterology , confidence interval , cyclophosphamide , surgery , chemotherapy
Summary JCOG 9801, a randomized phase III trial, reported that vincristine, cyclophosphamide, doxorubicin and prednisone ( VCAP ); doxorubicin, ranimustine and prednisone ( AMP ); and vindesine, etoposide, carboplatin and prednisone ( VECP ) ( VCAP ‐ AMP ‐ VECP ; mLSG 15) showed superior clinical outcomes when compared to cyclophosphamide, doxorubicin, vincristine and prednisone every 2 weeks ( CHOP ‐14; mLSG 19) in patients with untreated aggressive adult T‐cell leukaemia‐lymphoma ( ATL ). To identify patients who require VCAP ‐ AMP ‐ VECP , we conducted a supplementary analysis of JCOG 9801. Overall, 105 patients were included and categorized into low‐ ( n = 44), intermediate‐ ( n = 54) and high‐risk ( n = 7) groups according to the age‐adjusted ATL prognostic index ( ATL ‐ PI ). We excluded the high‐risk group due to small numbers of patients. VCAP ‐ AMP ‐ VECP did not show any superior trend for overall survival ( OS ) in the low‐risk group (hazard ratio: 1·04; 95% confidence interval: 0·54–2·04). Better OS was observed in the intermediate‐risk group treated with VCAP ‐ AMP ‐ VECP (hazard ratio: 0·65; 95% confidence interval: 0·36–1·19). In the intermediate‐risk group, the VCAP ‐ AMP ‐ VECP arm showed higher complete response rates than the CHOP ‐14 arm (44·0% vs. 13·8%). The VCAP ‐ AMP ‐ VECP arm in both risk groups exhibited grade 4 thrombocytopenia, while grade 4 neutropenia was only observed in the intermediate‐risk group. VCAP ‐ AMP ‐ VECP remains suitable for the intermediate‐risk group, whereas its benefits appear modest in the low‐risk group.