Adult T cell leukaemia /
lymphoma (
ATLL) is a mature (post thymic)
T cell lymphoma caused by the human T-lymphotropic virus type 1 (HTLV-1)
infection. Overall survival in the aggressive subtypes (Acute Leukaemia and Lymphomatous) remains poor in part due to
chemotherapy resistance. To improve treatment outcome for de novo disease, better induction
therapies are required and since the pathogenic agent is known it would seem sensible to target the virus. In a recent meta-analysis the use of
zidovudine and
interferon alpha (ZDV/IFN) has been associated with improved response rates and prolonged overall survival in leukemic subtypes of
ATLL (both acute and Chronic) confirmed in a multivariate analysis. In a more recent UK study the overall response rate for patients with aggressive
ATLL treated with
chemotherapy alone was 49 % compared to 81 % with combined first line
therapy (
chemotherapy with concurrent or sequential ZDV/IFN). Combined first line
therapy prolonged median OS in acute (p = 0.0081) and lymphomatous
ATLL (p = 0.001).These data support the use of low dose ZDV/IFN with
chemotherapy as first line treatment for patients with newly diagnosed aggressive
ATLL. Although the mechanisms of action are incompletely understood, some possible explanations for their efficacy will be discussed.