Allogeneic hematopoietic stem cell transplantation for ATL with central nervous system involvement: the Nagasaki transplant group experience.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is regarded as a curative option for aggressive adult T cell leukemia-lymphoma (ATL). However, the efficacy and safety of allo-HSCT for ATL with central nervous system (CNS) involvement, which is highly resistant to chemotherapy, remain controversial. We analyzed 10 ATL patients with CNS involvement who received allo-HSCT at three institutions in Nagasaki prefecture between 2000 and 2007. The 3-year overall survival rate was 40%, and the median observation time of the four surviving patients was 1532 days (range 945-2212 days). Two of four surviving patients received highly intensive local treatment for the CNS; one with 26 intrathecal injections of antineoplastic agents, and the other with whole cerebrospinal irradiation before transplantation. However, the other two patients received conventional or reduced-intensity conditioning with standard intrathecal chemotherapy. Three of the four surviving patients experienced chronic GVHD, and two of three patients with grade 3 or 4 acute GVHD were free from CNS relapse. From these data, it seems that both intensive local treatment for CNS disease and systemic GVHD contributed to the long-term control of CNS involvement. Although our data suggest that allo-HSCT is a therapeutic option for ATL with CNS disease, high transplant-related mortality (six cases) indicates the need for further studies to develop more effective procedures for CNS disease, and to reduce transplant-related morbidity.

• Authors: Takuya Fukushima, Jun Taguchi, Yukiyoshi Moriuchi, Shinichiro Yoshida, Hidehiro Itonaga, Koji Ando, Yasushi Sawayama, Yoshitaka Imaizumi, Daisuke Imanishi, Tomoko Hata, Yasushi Miyazaki
• Journal: International journal of hematology (Int J Hematol) Vol. 94 Issue 4 Pg. 390-394 (Oct 2011) ISSN: 1865-3774 [Electronic] Japan
• PMID: 21960057 (Publication Type: Journal Article, Multicenter Study)

Topics

• Adult
• Central Nervous System Neoplasms (drug therapy, radiotherapy, therapy)
• Female
• Graft vs Host Disease
• Hematopoietic Stem Cell Transplantation (methods, mortality)
• Humans
• Injections, Spinal
• Leukemia-Lymphoma, Adult T-Cell (pathology, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Survival Rate
• Transplantation, Homologous
• Treatment Outcome