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Progress in Allogeneic Hematopoietic Cell Transplantation in Adult T-Cell Leukemia-Lymphoma
- Source :
- Frontiers in Microbiology, Frontiers in Microbiology, Vol 10 (2019)
- Publication Year :
- 2019
-
Abstract
- The prognosis of aggressive adult T-cell leukemia-lymphoma (ATL) remains poor because of frequent infections and drug resistance. Dose-intensified chemotherapy followed by autologous stem cell transplantation failed to improve the prognosis of patients with ATL; however, we first revealed that allogeneic hematopoietic cell transplantation (allo-HCT) might improve their prognosis. We showed that reduced-intensity stem cell transplantation using peripheral blood was feasible for elderly patients. Further, the prognosis of patients in remission, who receive cord blood transplantation, has been recently improved and is equivalent to that of patients who receive transplants from other stem cell sources. As for the timing of HCT, the patients who underwent transplantation early showed better outcomes than those who underwent transplantation late. Based on the analysis of patients with aggressive ATL, including those who received transplants, we identified five prognostic factors for poor outcomes: acute-type ATL, poor performance status, high soluble interleukin-2 receptor levels, hypercalcemia, and high C-reactive protein level. Next, we developed a new prognostic index: the modified ATL-PI. The overall survival (OS) rates were significantly higher in patients who underwent allo-HCT than those who did not in the intermediate and high-risk groups stratified using the modified ATL-PI. Two new anti-cancer agents, mogamulizumab and lenalidomide, were recently approved for ATL patients in Japan. They are expected to induce longer survival in ATL patients when administered along with transplantation. However, a retrospective analysis that the risk of severe, acute, and corticosteroid-refractory graft-versus-host disease was higher in patients who received mogamulizumab before allo-HCT, and that mogamulizumab might increase the transplant-related mortality (TRM) rates and decrease the OS rates compared to those of patients who did not receive mogamulizumab. However, our recent study showed that administration of mogamulizumab before allo-HCT tended to improve the survival of patients with ATL. In conclusion, allo-HCT procedures for patients with aggressive ATL have considerably progressed and have helped improve the prognosis of these patients; however, many concerns still remain to be resolved. Further development of allo-HCT by using new molecular targeting agents is required for the improvement of cure rates in patients with ATL.
- Subjects :
- Microbiology (medical)
Oncology
medicine.medical_specialty
graft-versus-ATL effect
medicine.medical_treatment
lcsh:QR1-502
HTLV-1 proviral load
Review
molecular targeting agent
Microbiology
lcsh:Microbiology
Adult T-cell leukemia/lymphoma
03 medical and health sciences
Autologous stem-cell transplantation
immune system diseases
Internal medicine
hemic and lymphatic diseases
medicine
Mogamulizumab
030304 developmental biology
Lenalidomide
0303 health sciences
Chemotherapy
allogeneic hematopoietic cell transplantation
030306 microbiology
business.industry
mogamulizumab
Immunotherapy
medicine.disease
Transplantation
surgical procedures, operative
ATL
HTLV-1
immunotherapy
Stem cell
business
medicine.drug
Subjects
Details
- ISSN :
- 1664302X
- Volume :
- 10
- Database :
- OpenAIRE
- Journal :
- Frontiers in microbiology
- Accession number :
- edsair.doi.dedup.....78678980e6b42b105ebee084f31c1e29