THE EFFECT OF LONG‐TERM MAINTENANCE CHEMOTHERAPY FOR AGGRESSIVE ADULT T CELL LEUKEMIA/LYMPHOMA

Abstract

Introduction: In aggressive adult T-cell leukemia/lymphoma (ATL), the prognosis is extremely poor. The reasons are the invasion of multiple organs, drug resistance, immune deficiency and an attack at old age. Recently, mLSG15 regimen is thought to the standard therapy and improves the prognosis, but the median survival time (MST) is 13 months (ms). Intensive chemotherapy is repeated in mLSG15 regimen, it is difficult to refrain for frail or elderly patients. Moreover, intensive chemotherapy makes their quality of life (QOL) to be poor. Anti-CCR4 antibody therapy is useful too. Though, the prognosis of ATL is still remained worse than the other lymphoma. In our hospital, some patients received long-term maintenance chemotherapy (MC). Among these patients, 8 of 16 were achieved long-term survival, longer than 30 ms. Therefore, to confirm the effect of MC, the retrospective study was performed under the permission of the Institutional Review Board. Methods: Except smoldering and chronic type, in aggressive ATL treated in our hospital from April 2003 to September 2014, eligible 30 cases were analyzed. Their median age was 68 years old. Acute type was 11 cases, and lymphoma type was 19 cases. They received some induction therapy, respectively. Thirty cases were classified into three groups. Group 0 contained 14 cases not received MC and includes 9 high risk (HIGH) cases. Either in remission or not, 16 of 30 cases received MC continuously as long as possible. Group 1 contained 11 cases and received oral administration of MC with sobuzoxane (SBZ): 400 mg and etoposide (ETO): 25 mg, twice a week to once 3 weeks, include 7 cases of intermediate risk (INT) and 2 cases of low risk (LOW). Group 2 contained 5 without HIGH cases received MC intravenous administration of respective way with cyclophosphamide, ifosfamide, ETO, MTX or VCR, etc. Risk classification adopted Katsuya's study. Results: MST of groups 0, 1, and 2 were 2.5, 31, and 12.5 ms. For about group 1 + 2, it was the cohort that received MC; MST was apparently longer than group 0 (25 vs 2.5 ms). The cases received MC were longer MST than that of already known in Japan, HIGH (6.3 vs 3.6 ms), INT (31 vs 7 ms), LOW (32.5 vs 16.2 ms) and acute type (12.8 vs 8.3 ms), lymphoma type (32.3 vs 10.6 ms). Adverse event did not arise. MC contributed to economic benefits, too. Conclusions: With MC, MST was far superior to another, for example, in our data (25 vs 2.5 ms) or Japanese already known data. Between group 1 and 2, MST (31 ms) of group 1 was excellent. Group 0 contained many HIGH cases that meant poor prognosis and needed more intensive therapy than MC. In opposition, group 1 + 2 contained many frail and/or with complications cases, so that they could not receive enough standard therapy but received inevitably mild MC. Thus long-term MC is highly recommended for QOL and longer term survival of ATL, especially in INT, LOW and lymphoma type of ATL with unacceptable to the transplantation.