Abstract
Adult T-cell leukemia (ATL) is an indolent leukemia caused by type 1 human T-cell leukemia virus (HTLV-1). A variety of therapeutic interventions via immunological approaches have been attempted. ATL cells express costimulatory molecules of natural killer (NK) cells, and a new modality—amplified NK (ANK) cell treatment—was administered here to a patient with ATL. A 70-year-old female presenting with ringworm infection received a diagnosis of smoldering ATL in 2004. Monitoring of soluble IL-2 receptors (sIL-2Rs) in the serum showed disease exacerbation in 2007, associated with the enlargement of lymph nodes and formation of a skin tumor. NK cells were amplified by in vitro cell culture methods. To avoid cytokine release syndrome, 2–5 × 108 cells were administered with each injection. A total of 15 injections from 12 November 2007 to 15 February 2008 were administered to this patient. This case showed drastic downregulation of sIL-2R, resulting in the induction of complete remission, which lasted for >5 years. This is the first report of treatment of a patient with ATL using ANK cell therapy. More attempts of this therapy will enhance our insight into the appropriate application of this new therapy to clinically diverse patients.
Highlights
Identification of human T cells by an antithymocyte antibody, in addition to the classical method of rosette formation with sheep red blood cells, became possible in the 1970s
It has been described as adult T-cell leukemia-lymphoma (ATLL) [6]
The therapy of patients with ATLL based on their immunological features has been initiated using an anti-CD25 monoclonal antibodies (mAbs) because CD25 is overexpressed in ATL cells
Summary
Identification of human T cells by an antithymocyte antibody, in addition to the classical method of rosette formation with sheep red blood cells, became possible in the 1970s. After the reports of HTLV-1 occurrence, ATL was classified into four clinical subtypes: acute, chronic, lymphoma, and smoldering [5] It has been described as adult T-cell leukemia-lymphoma (ATLL) [6]. The therapy of patients with ATLL based on their immunological features has been initiated using an anti-CD25 mAb because CD25 is overexpressed in ATL cells. This therapy is based on a humanized monoclonal antibody that blocks IL-2 binding by recognizing the interleukin-2 receptor α chain (CD25). Anti-CCR4 mAb therapy (mogamulizumab) was used after discovering that ~90% of ATL cells are positive for CCR4 [15] This therapy, requiring only 1 mg/kg antibody, has been found to be effective at treating patients with. We believe that the ANK cell treatment of ATL is a rational approach
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