Acute
leukemia and
lymphoma varieties of
adult T-cell leukemia/lymphoma (ATL) usually carry a poor prognosis. While
etoposide is generally useful for treating ATL, especially as a daily oral maintenance regimen,
etoposide has not proven effective in severe types of ATL efficient in some patients. Of 87 ATL patients whom we have treated, 51 had acute
leukemia, 22
lymphoma and 14 progressive chronic
leukemia. Seventy-nine patients were treated with a long term maintenance combination protocol, OPEC/MPEC (weekly doses of
vincristine, 0.7 mg/m2 or
methotrexate, 14 mg/m2;
prednisolone, 20 mg/m2;
etoposide, 70 mg/m2 and
cyclophosphamide, 200 mg/m2). The other 8 patients, 3 with acute
leukemia, 2 with
lymphoma and 3 with progressive chronic
leukemia, were treated with daily
oral administration of 25 mg of
etoposide and 10 mg of
prednisolone (DOEP). The dose administered was modified in individual cases to maintain the granulocyte count and reduce the number of ATL cells. Considering both protocols, a complete response and a partial response were achieved in 31.0% and 58.6% patients, respectively. Median survival times (MST) of all patients and, acute
leukemia,
lymphoma and progressive chronic
leukemia types were 7.5, 6.7, 9.6 and 12.4 months, respectively. Respective MST of patients treated with OPEC/MPEC or DOEP protocols were 7.1 and 18.0 months. Relatively normal WBC counts, lower
lactate dehydrogenase concentration and normal
calcium concentration, limited numbers of anatomic sites involved, good performance status and good response to
chemotherapy were significantly associated with long survival time.
Drug toxicity was not apparent, and about half of patients were treated in an outpatient setting.