Development of a modified prognostic index for patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: Possible risk-adapted management strategies including allogeneic transplantation

Shigeo Fuji, Takuhiro Yamaguchi, Yoshitaka Inoue, Atae Utsunomiya, Yukiyoshi Moriuchi, Kaoru Uchimaru, Satsuki Owatari, Takashi Miyagi, Jun Taguchi, Ilseung Choi, Eiichi Otsuka, Sawako Nakachi, Hisashi Yamamoto, Saiko Kurosawa, Kensei Tobinai, Takahiro Fukuda

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

Adult T-cell leukemia-lymphoma is a distinct type of peripheral Tcell lymphoma caused by human T-cell lymphotropic virus type I. Although allogeneic stem cell transplantation after chemotherapy is a recommended treatment option for patients with aggressive adult T-cell leukemia-lymphoma, there is no consensus about indications for allogeneic stem cell transplantation because there is no established risk stratification system for transplant eligible patients. We conducted a nationwide survey of patients with aggressive adult T-cell leukemia-lymphoma in order to construct a new, large database that includes 1,792 patients aged 70 years or younger with aggressive adult T-cell leukemialymphoma who were diagnosed between 2000 and 2013 and received intensive first-line chemotherapy. We randomly divided patients into two groups (training and validation sets). Acute type, poor performance status, high soluble interleukin-2 receptor levels (> 5,000 U/mL), high adjusted calcium levels (≥ 12 mg/dL), and high C-reactive protein levels (≥ 2.5 mg/dL) were independent adverse prognostic factors used in the training set. We used these five variables to divide patients into three risk groups. In the validation set, median overall survival for the low-, intermediate-, and high-risk groups was 626 days, 322 days, and 197 days, respectively. In the intermediate- and high-risk groups, transplanted recipients had significantly better overall survival than non-transplanted patients. We developed a promising new risk stratification system to identify patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who may benefit from upfront allogeneic stem cell transplantation. Prospective studies are warranted to confirm the benefit of this treatment strategy.

Original languageEnglish
Pages (from-to)1258-1265
Number of pages8
JournalHaematologica
Volume102
Issue number7
DOIs
Publication statusPublished - 2017 Jun 26
Externally publishedYes

ASJC Scopus subject areas

  • Hematology

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