Abstract
The standard of care for indolent adult T-cell leukemia-lymphoma (iATL) has been considered to be a watch and wait in Japan. While, an International Consensus Meeting recommended considering combination of interferon-alpha and zidovudine (IFN/AZT) or watch and wait if patients are symptomatic, and watch and wait if patients are asymptomatic.A Japanese retrospective analysis revealed that conventional chemotherapy did not improve the prognosis of patients with iATL, but no prospective confirmation is reported. A certain number of iATL patients have skin lesions, and these could be treated by skin-directed therapy such as topical steroids, ultraviolet light, and radiation, and/or systemic therapy such as steroids, oral retinoids, interferon-gamma, or single agent chemotherapy; however the beneficial effects of these approaches on prognosis of the patients have not yet been confirmed. Two recent Japanese retrospective studies reported that the prognosis of iATL mainly observed by employing a watch and wait approach was poorer than expected, and comparable to that of chronic myelogenous leukemia in chronic phase before imatinib era. On the other hand, a retrospective meta-analysis reported 5-year survival rate of 100 % and 42 % in patients with chronic and smoldering type ATL treated by IFN/AZT and chemotherapy, respectively. The number of patients included in the analysis was very small and possible bias due to its retrospective nature cannot be avoided; hence, a prospective study is eagerly warranted. The Japan Clinical Oncology Study Group (JCOG) has started a phase III study comparing IFN/AZT with watch and wait for iATL (JCOG1111; UMIN000011805). This study will validate the efficacy of early intervention for iATL by IFN/AZT in Japanese populations.The important issues for evaluating the efficacy of early intervention to iATL are benefit for overall survival but not progression free survival, its toxicities, and cost/benefit.
Published Version
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