Successful Treatment of HTLV-1-associated Acute Adult T-Cell Leukemia by Allogeneic Bone Marrow Transplantation

Abstract

P121 A 42 year-old male with HTLV-1-associated acute adult T-Cell leukemia (ATL), treated with carcinostatic agents, followed by successful allogeneic bone marrow transplantation(BMT), and remaining in complete remission 5 months after BMT is described. He was admitted in November, 1997 by bilateral cervical lymphadenopathy but free from both hepatosplenomegaly and skin lesion. His white blood cell count was 16.5× 109/l with 7% of abnormal lymphocytes. Pathology of a lymph node revealed malignant lymphoma (diffuse, pleomorphic type with T-cell phenotype). Serum anti-HTLV-1 antibody was positive. These findings lead him to the diagnosis of acute type of ATL. He was treated with cyclophosphamide, adriamycin, vincristine, and prednisolone followed by BMT from an HLA identical sibling on June 10, 1998 resulting in a complete remission. The conditioning regimen consisted of L-PAM and total body irradiation. GVHD prophylaxis was performed with cyclosporine A and short term methotrexate administration. His WBC count increased more than 1.0×109/l 14 day after BMT and platelet count elevated to 50.0×109/l on the 27th day. Complications of acute GVHD (grade 2) appeared with watery diarrhea and cytomegalovirus antigenemia, which were resolved with predonisolone and gancyclovir respectively. He still remains in complete remission 5 months after BMT. Although the efficacy of allogeneic BMT (allo-BMT) for ATL was still uncertain, he was treated successfully by allo-BMT without any life threatening complications. Conclusion: allo-BMT can be one of the best choice for the treatment of ATL.