Use of Zidovudine and Interferon Alfa With Chemotherapy Improves Survival in Both Acute and Lymphoma Subtypes of Adult T-Cell Leukemia/Lymphoma

TY - JOUR

T1 - Use of Zidovudine and Interferon Alfa With Chemotherapy Improves Survival in Both Acute and Lymphoma Subtypes of Adult T-Cell Leukemia/Lymphoma

AU - Hodson, Andrew

AU - Crichton, Siobhan

AU - Montoto, Silvia

AU - Mir, Naheed

AU - Matutes, Estella

AU - Cwynarski, Kate

AU - Kumaran, Thurai

AU - Ardeshna, Kirit M.

AU - Pagliuca, Tony

AU - Taylor, Graham P.

AU - Fields, Paul

PY - 2011/12/10

Y1 - 2011/12/10

N2 - PurposeAdult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-alpha) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis.Patients and MethodsWe report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-alpha on treatment response and survival was assessed.ResultsThe overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-alpha). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-alpha at any time prolonged survival in acute (P <.001) and lymphoma ATLL (P <.001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone.ConclusionThese data support the use of low-dose ZDV/IFN-alpha with chemotherapy in first-line treatment of acute and lymphoma ATLL.

AB - PurposeAdult T-cell leukemia/lymphoma (ATLL) is a mature (post-thymic) T-cell lymphoma associated with human T-lymphotropic virus type 1 infection. Survival in aggressive subtypes remains poor, and treatment resistance is frequent. Use of zidovudine (ZDV) and interferon alfa (IFN-alpha) has been associated with improved response rates in small studies and prolonged overall survival in leukemic ATLL subtypes in a recent meta-analysis.Patients and MethodsWe report the clinicopathologic characteristics, treatment, and outcome of 73 patients with aggressive ATLL (acute ATLL, 29; lymphoma ATLL, 44) diagnosed and treated in England between 1999 and 2009. The impact of ZDV/IFN-alpha on treatment response and survival was assessed.ResultsThe overall response rate ranged from 49% with chemotherapy alone to 81% with combined first-line therapy (chemotherapy with concurrent/sequential ZDV/IFN-alpha). Median overall survival (OS) was 9 months: 7.5 months for acute ATLL and 10 months for lymphoma ATLL. Use of ZDV/IFN-alpha at any time prolonged survival in acute (P <.001) and lymphoma ATLL (P <.001) and was the sole factor associated with reduction in risk of death in aggressive ATLL (hazard ratio, 0.23; 95% CI, 0.09 to 0.60; P = .002). Combined first-line therapy prolonged median OS in acute (P = .0081) and lymphoma ATLL (P = .001) compared with chemotherapy alone.ConclusionThese data support the use of low-dose ZDV/IFN-alpha with chemotherapy in first-line treatment of acute and lymphoma ATLL.

U2 - 10.1200/JCO.2011.35.5578

DO - 10.1200/JCO.2011.35.5578

M3 - Article

SN - 1527-7755

VL - 29

SP - 4696

EP - 4701

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

IS - 35

ER -