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Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study

2010; Elsevier BV; Volume: 116; Issue: 8 Linguagem: Inglês

10.1182/blood-2009-10-247510

1528-0020

Masakatsu Hishizawa, Junya Kanda, Atae Utsunomiya, Shuichi Taniguchi, Tetsuya Eto, Yukiyoshi Moriuchi, Ryuji Tanosaki, Fumio Kawano, Yasushi Miyazaki, Masato Masuda, Koji Nagafuji, Masamichi Hara, Minoko Takanashi, Shunro Kai, Yoshiko Atsuta, Ritsuro Suzuki, Takakazu Kawase, Keitaro Matsuo, Tokiko Nagamura‐Inoue, Shunichi Kato, Hisashi Sakamaki, Yasuo Morishima, Jun Okamura, Tatsuo Ichinohe, Takashi Uchiyama,

Animal Disease Management and Epidemiology

Abstract Allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly used as a curative option for adult T-cell leukemia (ATL), an intractable mature T-cell neoplasm causally linked with human T-cell leukemia virus type I (HTLV-I). We compared outcomes of 386 patients with ATL who underwent allogeneic HSCT using different graft sources: 154 received human leukocyte antigen (HLA)–matched related marrow or peripheral blood; 43 received HLA-mismatched related marrow or peripheral blood; 99 received unrelated marrow; 90 received single unit unrelated cord blood. After a median follow-up of 41 months (range, 1.5-102), 3-year overall survival for entire cohort was 33% (95% confidence interval, 28%-38%). Multivariable analysis revealed 4 recipient factors significantly associated with lower survival rates: older age (> 50 years), male sex, status other than complete remission, and use of unrelated cord blood compared with use of HLA-matched related grafts. Treatment-related mortality rate was higher among patients given cord blood transplants; disease-associated mortality was higher among male recipients or those given transplants not in remission. Among patients who received related transplants, donor HTLV-I seropositivity adversely affected disease-associated mortality. In conclusion, allogeneic HSCT using currently available graft source is an effective treatment in selected patients with ATL, although greater effort is warranted to reduce treatment-related mortality.