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Blood, 15 May 2005, Vol. 105, No. 10, pp. 4143-4145.
Prepublished online as a Blood First Edition Paper on January 21, 2005; DOI 10.1182/blood-2004-11-4193.
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Submitted November 2, 2004
Accepted January 12, 2005
Allogeneic stem cell transplantation with reduced conditioning intensity as a novel immunotherapy and antiviral therapy for adult T-cell leukemia/lymphoma
Jun Okamura*, Atae Utsunomiya, Ryuji Tanosaki, Naokuni Uike, Shunro Sonoda, Mari Kannagi, Masao Tomonaga, Mine Harada, Nobuhiro Kimura, Masato Masuda, Fumio Kawano, Yuji Yufu, Hiroyoshi Hattori, Hiroshi Kikuchi, and Yoshio Saburi
Institute for Clinical Research, National Kyushu Cancer Center, Fukuoka, Japan
Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan
Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan
Department of Hematology, National Kyushu Cancer Center, Fukuoka, Japan
Department of Virology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
Department of Immunotherapeutics, Tokyo Medical and Dental University, Medical Research Division, Tokyo, Japan
Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
First Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
Second Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
Institute for Clinical Research, Kumamoto National Hospital, Kumamoto, Japan
Blood Transfusion Service, Oita University, Faculty of Medicine, Oita, Japan
Department of Hematology, Oita Prefectural Hospital, Oita, Japan
* Corresponding author; email: jyokamur{at}nk-cc.go.jp.
Sixteen patients with adult T-cell leukemia/lymphoma (ATL) who were all over 50 years of age underwent allogeneic stem cell transplantation with reduced conditioning intensity (RIST) from HLA-matched sibling donors after a conditioning regimen consisted of fludarabine (180 mg/m2), busulfan (8 mg/kg) and rabbit antithymocyte globulin (5 mg/kg). The observed regimen-related toxicities and non-hematological toxicities were all found to be acceptable. A disease relapse was the main cause of treatment failure. Three patients who relapsed subsequently responded to a rapid discontinuation of the immunosuppressive agent and thereafter achieved another remission. After RIST, the human T-cell leukemia virus type I (HTLV-I) proviral load became undetectable in 8 patients. RIST is thus considered to be a feasible treatment for ATL. Our data also suggest the presence of a possible graft-versus-ATL effect while an anti-HTLV-I activity was also found to be associated with this procedure.
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