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Role of up-front allogeneic hematopoietic stem cell transplantation for patients with aggressive adult T-cell leukemia-lymphoma: a decision analysis

Bone Marrow Transplantation volume 53, pages 905–908 (2018)Cite this article

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Adult T-cell leukemia-lymphoma (ATL) is a distinct peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I with a dismal outcome [1,2,3,4]. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a promising treatment option for patients with aggressive ATL [3, 5]. However, there is still no consensus whether all patients with aggressive ATL should undergo an up-front allo-HSCT. Although retrospective analyses suggested the presence of survival benefit of up-front allo-HSCT compared with chemotherapy alone in patients with intermediate- or high-risk ATL [3], presence of significant selection bias made it difficult to assess the equipoise of the two treatments. A prospective randomized clinical trial (RCT) is desirable to clarify the benefit of up-front allo-HSCT, but it has never been conducted.

In order to address this problem, we here undertook a decision analysis using database the database of 1792 patients with aggressive ATL [3, 6]. Decision analysis is a computerized modeling analysis that can simulate the clinical outcomes of different therapeutic strategies and identify an appropriate therapeutic strategy. This study was approved by the institutional review board of the National Cancer Center, Tokyo, Japan (No. 2014–179). Patients were stratified into the low-, intermediate-, and high-risk groups according to the modified ATL-prognostic index using the prognostic factors, including disease type (acute type), poor performance status, high soluble interleukin-2 receptor level ( > 5000 U/mL), high adjusted calcium level ( ≥ 12 mg/dL), and high C-reactive protein level ( ≥ 2.5 mg/dL) [3].

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Funding

This research was partially supported by the Practical Research for Innovative Cancer Control from the Japan Agency for Medical Research and Development (15Ack0106136h0002) and the National Cancer Research and Development Fund (26-A-26).

Author contributions

SF, SK, YI, TM, TY, and TF participated in research design, data analysis, and manuscript writing. AU, KU, SY, YI, YM, IC, MO, and MH gathered the data. All authors approved the submission of this manuscript.

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Authors and Affiliations

  1. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Shigeo Fuji, Saiko Kurosawa, Yoshihiro Inamoto & Takahiro Fukuda

  2. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Shigeo Fuji

  3. Crecon Medical Assessment Inc, Tokyo, Japan

    Tatsunori Murata

  4. Department of Hematology, Imamura Bun-in Hospital, Kagoshima, Japan

    Atae Utsunomiya

  5. Department of Hematology/Oncology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Kaoru Uchimaru

  6. Department of Hematology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan

    Satoshi Yamasaki

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

    Yoshitaka Inoue

  8. Department of Hematology, Sasebo City General Hospital, Sasebo, Japan

    Yukiyoshi Moriuchi

  9. Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Ilseung Choi

  10. Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan

    Masao Ogata

  11. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Michihiro Hidaka

  12. Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan

    Takuhiro Yamaguchi

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  1. Shigeo Fuji
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  13. Takuhiro Yamaguchi
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  14. Takahiro Fukuda
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Corresponding author

Correspondence to Shigeo Fuji.

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Conflict of interest

SF received honoraria from Kyowa Hakko Kirin Co., Ltd.; TM is an employee of Crecon Medical Assessment Inc, Tokyo, Japan.; AU received honoraria from Japan Blood Products Organization, Roche Diagnostics, Daiichi Sankyo, Siemens, Bristol-Myers Squibb, Pfizer, Astellas Pharma, Kyowa Hakko Kirin, Novartis Pharma, HUYA Bioscience International, Nippon Shinyaku, Chugai Pharma and Celgene, Immuno-Biological Laboratories, and Sumitomo Dainippon Pharma.; TY had ownership interests of Statcom Co., Ltd., received consulting fee from Ono Pharmaceutical Co., Ltd., received honoraria from Taiho Pharmaceutical Co., Ltd., and received research funding from Kyowa Hakko Kirin Co., Ltd.; MH received research funding from Chugai Pharm Co., Ltd. The remaining authors declare that they have no conflict of interest.

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Fuji, S., Kurosawa, S., Inamoto, Y. et al. Role of up-front allogeneic hematopoietic stem cell transplantation for patients with aggressive adult T-cell leukemia-lymphoma: a decision analysis. Bone Marrow Transplant 53, 905–908 (2018). https://doi.org/10.1038/s41409-017-0082-4

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  • DOI: https://doi.org/10.1038/s41409-017-0082-4

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