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International Journal of Hematology

, Volume 109, Issue 4, pp 402–408 | Cite as

Clinical features at transformation in adult T-cell leukemia–lymphoma with smoldering and chronic types

  • Hiroaki Taniguchi
  • Yoshitaka ImaizumiEmail author
  • Yumi Takasaki
  • Jun Nakashima
  • Takeharu Kato
  • Hidehiro Itonaga
  • Shinya Sato
  • Yasushi Sawayama
  • Koji Ando
  • Hiroo Hasegawa
  • Tomoko Hata
  • Yukiyoshi Moriuchi
  • Kunihiro Tsukasaki
  • Yasushi Miyazaki
Original Article
  • 122 Downloads

Abstract

Watchful waiting (WW) is among the treatment options indicated for patients with indolent adult T-cell leukemia–lymphoma (ATL). However, we previously showed that the long-term prognosis of patients with smoldering and chronic ATL is often worse than expected, with many undergoing transformation to aggressive ATL. To identify clinical features associated with transformation of smoldering/chronic ATL, we retrospectively analyzed the clinical features of 44 patients (14 smoldering and 30 chronic) who experienced transformation during WW. An elevated lactate dehydrogenase (LDH) value was most often observed (n = 30) at the time of transformation, especially in the chronic type (n = 24). Major organ involvement, lymphadenopathy, and hypercalcemia were shown to be associated with transformation in transformed patients without elevated LDH. The median overall survival time after transformation was only 7.8 months, and the prognosis was poor after transformation in those fulfilling the criteria of acute type, similar to that of de novo aggressive ATL. Laboratory data, such as LDH, and clinical signs including exacerbation of performance status, skin lesions, and lymphadenopathy should all be monitored during WW to ensure appropriate timing of chemotherapy initiation. Identification of optimal predictive markers for transformation and new therapeutic options is warranted to improve outcomes in indolent ATL.

Keywords

Adult T-cell leukemia–lymphoma (ATL) Transformation Smoldering Chronic 

Notes

Acknowledgements

We thank the hematologists of the Department of Hematology, Nagasaki University Hospital, for their work in diagnosis and treatment of patients with ATL. KT was supported in part by Japan Agency for Medical Research and Development under Grant number JP18ck0106338.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Hiroaki Taniguchi
    • 1
  • Yoshitaka Imaizumi
    • 2
    Email author
  • Yumi Takasaki
    • 3
  • Jun Nakashima
    • 2
  • Takeharu Kato
    • 1
  • Hidehiro Itonaga
    • 2
  • Shinya Sato
    • 2
  • Yasushi Sawayama
    • 2
  • Koji Ando
    • 2
  • Hiroo Hasegawa
    • 4
  • Tomoko Hata
    • 2
  • Yukiyoshi Moriuchi
    • 1
  • Kunihiro Tsukasaki
    • 5
  • Yasushi Miyazaki
    • 2
  1. 1.Department of HematologySasebo City General HospitalSaseboJapan
  2. 2.Department of HematologyNagasaki University HospitalNagasakiJapan
  3. 3.Department of HematologySaint Francis HospitalNagasakiJapan
  4. 4.Department of Laboratory MedicineNagasaki University HospitalNagasakiJapan
  5. 5.Department of Hematology, International Medical CenterSaitama Medical UniversitySaitamaJapan

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