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Validation of the iATL-PI prognostic index in therapeutic decision-making for patients with smoldering and chronic ATL: a multicenter study

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Abstract

Adult T cell leukemia-lymphoma (ATL) is clinically heterogeneous and is classified into four subtypes: acute, lymphoma, chronic, and smoldering. Recently, a new prognostic index based on the value of soluble interleukin-2 receptor, denoted the “iATL-PI,” has been proposed for patients with smoldering and chronic ATL. To evaluate the effectiveness of the iATL-PI, we re-analyzed our previously published data on 176 patients with smoldering or chronic ATL (76 smoldering, 100 chronic) diagnosed between 2010 and 2011, as well data from the subsequent follow-up study on prognosis between 2016 and 2017. The proportions for the low-, intermediate-, and high-risk iATL-PI groups at the time of ATL diagnosis were 44.7%, 48.7%, and 5% for smoldering ATL; 6.3%, 71.9%, and 21.9% for favorable chronic ATL; and 5.9%, 27.9%, and 66.2% for unfavorable chronic ATL, respectively. The survival of patients with smoldering or chronic ATL as a whole was significantly stratified according to the three iATL-PI groups. Most patients with unfavorable chronic ATL in the low iATL-PI risk group had indolent clinical courses. Our results showed that iATL may become a useful tool to predict the prognosis of smoldering and chronic ATL, which have diverse clinical courses.

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Abbreviations

ATL:

Adult T cell leukemia-lymphoma

BUN:

Blood urea nitrogen

CIR:

Cumulative incidence rate

95% CI:

95% Confidence interval

SC:

Starting chemotherapy

HTLV-I:

Human T cell leukemia virus type I

IRB:

Institutional review board

iATL-PI:

Indolent ATL Prognostic Index

LDH:

Lactate dehydrogenase

MST:

Median survival time

NE:

Not able to estimate or not able to be evaluated

NR:

Not reached

OS:

Overall survival

PI:

Prognostic index

sIL2R:

Soluble interleukin-2 receptor

TSC:

Time to starting chemotherapy

WBC:

White blood cell

WW:

Watchful waiting

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Acknowledgements

We thank all the investigators in the hospitals participating in this study, which are listed in the appendix. We thank Dr. Masanori Shimoyama for providing expert opinions regarding this study. This work was partially supported by Grants-in-Aid from the Ministry of Health, Labor, and Welfare of Japan (Grant numbers: H23-GanRinsho-Ippan-020 and H26-GanSeisaku-Ippan-006) to MI, KU, TW, and KT, and by the Japan Agency for Medical Research and Development (Grant numbers: 17ck0106338h0001 and 18ck0106338s0502) to YI, MI, KN, SI, KI, AU, and KT. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Hematology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Yoshitaka Imaizumi

  2. Department of Clinical Epidemiology, Nagasaki University School of Medicine, Nagasaki, Japan

    Masako Iwanaga

  3. Department of Hematology, Kumamoto University Hospital, Kumamoto, Japan

    Kisato Nosaka

  4. Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan

    Kenji Ishitsuka

  5. Department of Third Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan

    Kenichi Ishizawa

  6. Department of Hematology and Oncology, Iwate Medical University, Iwate, Japan

    Shigeki Ito

  7. Department of Dermatology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan

    Masahiro Amano

  8. Department of Immunology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Takashi Ishida

  9. Department of Hospice Care, St. Mary’s Hospital, Kurume, Japan

    Naokuni Uike

  10. Department of Hematology, Imamura General Hospital, Kagoshima, Japan

    Atae Utsunomiya

  11. Department of Pathology, Kurume University School of Medicine, Kurume, Japan

    Koichi Ohshima

  12. Department of Hematology, Tokyo Woman’s Medical University, Tokyo, Japan

    Junji Tanaka

  13. Department of Dermatology and Skin Oncology, Allergic Disease Research Center, Chutoen General Medical Center, Kakegawa, Japan

    Yoshiki Tokura

  14. Department of Hematology, National Cancer Center Hospital, Tokyo, Japan

    Kensei Tobinai

  15. Department of Practical Management of Medical Information, Graduate School of Medicine, St. Marianna University, Kanagawa, Japan

    Toshiki Watanabe

  16. Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan

    Kaoru Uchimaru

  17. Department of Hematology, International Medical Center, Saitama Medical University, Saitama, Japan

    Kunihiro Tsukasaki

Authors
  1. Yoshitaka Imaizumi
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  2. Masako Iwanaga
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  3. Kisato Nosaka
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  4. Kenji Ishitsuka
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  5. Kenichi Ishizawa
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  6. Shigeki Ito
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  7. Masahiro Amano
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  8. Takashi Ishida
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  9. Naokuni Uike
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  10. Atae Utsunomiya
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  11. Koichi Ohshima
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  12. Junji Tanaka
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  13. Yoshiki Tokura
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  14. Kensei Tobinai
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  15. Toshiki Watanabe
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  16. Kaoru Uchimaru
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  17. Kunihiro Tsukasaki
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Contributions

YI, MI, and KT organized the study and wrote the manuscript. YI and MI analyzed the data. YI, MI, KN, SI, KI, and KT reviewed the study sheets. MA, YT, and KO provided expert opinions on the skin lesions and pathology of patients. KI, TI, NU, AU, JT, KT, KU, and TW provided expert opinions and reviewed the manuscript.

Corresponding author

Correspondence to Yoshitaka Imaizumi.

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Conflict of interest

Kisato Nosaka reports consulting fees from Kyowa Kirin and honoraria from Celgene, Meiji Seka Pharma, Janssen Pharmaceutical, Bristol Myers Squbb, Abbie, Daiichi Sankyo, and Novartis. Kenji Ishitsuka reports grants from Ono Pharmaceutical and Kyowa Kirin, consulting fees from Daiichi-Sankyo, and honoraria from Chugai Pharmaceutical and Meiji Seika Pharma. Kenichi Ishizawa reports grants from SymBio, IQVIA, Novartis, Abbie, Zenyaku, and Otsuka Pharmaceutical, consulting fees from SAWAI, Micron, and Kyowa Kirin, and honoraria from Novartis, Takeda, Bristol Myers Squbb, Ono Pharmaceutical, Chugai Pharmaceutical, Eisai, and Janssen Pharmaceutical. Atae Utsunomiya reports consulting fees from JIMRO and Otsuka Medical Devices and honoraria from Bristol Myers Squbb and Meiji Seka Pharma. Koichi Oshima reports honoraria from Chugai Pharmaceutical, Kyowa Kirin, and Takeda. Kuhnihiro Tsukasaki reports consulting fees from Ono Pharmaceutical, Meiji Seka Pharma, Yakuruto, Solasia Pharma, Meiji Seika Pharma, and HUYABIO, honoraria from Chugai Pharmaceutical, Eizai, and Meiji Seika Pharma, and research funding from Kyowa Kirin, Meiji Seika Pharma, Celgene, Byer, Daiich-Sankyo, HUYABIO, and Regeneron Pharmaceuticals. All remaining authors have no conflicts of interest to declare.

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Supplementary Information

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12185_2022_3473_MOESM1_ESM.jpg

Supplemental Fig. 1. A. Overall survival (OS) and B. cumulative probability of starting chemotherapy in patients with favorable chronic ATL with or without lymph node lesions. LN; lymph node lesion. No.; number. (JPG 70 KB)

12185_2022_3473_MOESM2_ESM.jpg

Supplemental Fig. 2. A. Overall survival (OS) and B. cumulative probability of starting chemotherapy in patients with nodular/tumor-type skin lesions. No.; number (JPG 52 KB)

Appendix: Collaborative investigators in participating hospitals (DOCX 22 KB)

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Imaizumi, Y., Iwanaga, M., Nosaka, K. et al. Validation of the iATL-PI prognostic index in therapeutic decision-making for patients with smoldering and chronic ATL: a multicenter study. Int J Hematol 117, 206–215 (2023). https://doi.org/10.1007/s12185-022-03473-y

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  • DOI: https://doi.org/10.1007/s12185-022-03473-y

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