Current Oncology Reports

, Volume 15, Issue 5, pp 457–464 | Cite as

Therapeutic Options for Adult T-Cell Leukemia/Lymphoma

Lymphomas (PA Hamlin, Section Editor)

Abstract

Adult T-cell leukemia/lymphoma (ATL) is the first human malignancy associated with a retroviral infection and occurs in approximately 5 % of the 15 million to 20 million people infected by human T-cell lymphotropic virus 1. In general, ATL is resistant to chemotherapy, and while awaiting new therapeutics, patients commonly face a detrimental progress of the disease and death. The viral oncoprotein Tax is a key player in the cause of ATL and acts by interfering with DNA repair, cell cycle, apoptosis, and proliferative cellular programs. The Shimoyama classification describes four different subtypes (acute, lymphoma, chronic, and smoldering) associated with different outcomes, and that require different treatment strategies tailored to the clinical presentation. In aggressive ATL (acute and lymphoma subtypes), clinical trials, mostly from Japan, have demonstrated that combinations of chemotherapy can induce acceptable response rates, especially in the lymphoma subtype. However, the overall outcome remains extremely poor owing to a high rate of relapse. Similarly, the so-called indolent forms (smoldering and chronic subtypes) have a poor outcome whether they are managed with watching and waiting or treated with chemotherapy. We recently realized a worldwide meta-analysis and showed that the combination of zidovudine and interferon alpha is highly effective in the leukemic subtypes of ATL and should be considered as standard first-line therapy in that setting. This combination has changed the natural history of the disease through achievement of significantly improved long-term survival in patients with smoldering and chronic ATL as well as a subset of patients with acute ATL. Patients with lymphoma-type ATL still benefit from chemotherapy induction with concurrent or sequential antiretroviral therapy with zidovudine and interferon alpha. Allogeneic stem cell transplantation is a promising option but has several barriers. New drugs such as the new antibody anti-CXCR4 show promising results. Prospective trials testing maintenance therapy in order to avoid relapse are warranted when the patient cannot undergo allogeneic stem cell transplantation.

Keywords

Adult T-cell leukemia/lymphoma Human T-cell lymphotropic virus 1 Zidovudine Chemotherapy Interferon Arsenic 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Ambroise Marçais, Felipe Suarez, David Sibon, Laurent Frenzel, Olivier Hermine, and Ali Bazarbachi declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ambroise Marçais
    • 1
    • 2
  • Felipe Suarez
    • 1
    • 2
  • David Sibon
    • 1
    • 2
  • Laurent Frenzel
    • 1
    • 2
  • Olivier Hermine
    • 1
    • 2
  • Ali Bazarbachi
    • 3
  1. 1.Department of Hematology, Institut Imagine, Necker HospitalParis Descartes UniversityParis Cedex 15France
  2. 2.Institut ImagineUniversité Sorbonne Paris Cité, CNRS UMR8147ParisFrance
  3. 3.Department of Internal MedicineAmerican University of BeirutBeirutLebanon

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