Use of zidovudine and interferon alfa with chemotherapy improves survival in both acute and lymphoma subtypes of adult T-cell leukemia/lymphoma.

Abstract

PURPOSE:

Adult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-α) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis.

PATIENTS AND METHODS:

We report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-α on treatment response and survival was assessed.

RESULTS:

The overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-α). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-α at any time prolonged survival in acute (P < .001) and lymphoma ATLL (P < .001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone.

CONCLUSION:

These data support the use of low-dose ZDV/IFN-α with chemotherapy in first-line treatment of acute and lymphoma ATLL.

• Authors: Andrew Hodson, Siobhan Crichton, Silvia Montoto, Naheed Mir, Estella Matutes, Kate Cwynarski, Thurai Kumaran, Kirit M Ardeshna, Antonio Pagliuca, Graham P Taylor, Paul A Fields
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 29 Issue 35 Pg. 4696-701 (Dec 10 2011) ISSN: 1527-7755 [Electronic] United States
• PMID: 22042945 (Publication Type: Journal Article)

Chemical References

• Interferon-alpha
• Zidovudine

Topics

• Acute Disease
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Female
• Humans
• Interferon-alpha (administration & dosage)
• Leukemia-Lymphoma, Adult T-Cell (drug therapy, pathology)
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Young Adult
• Zidovudine (administration & dosage)