Abstract
A dose-intensified multi-agent chemotherapy regimen called VCAP-AMP-VECP was investigated in Japan as front-line therapy for patients with adult T-cell leukemia-lymphoma (ATL). Although a prospective randomized controlled study showed that VCAP-AMP-VECP was superior to CHOP, the trial was rather small and no subsequent studies confirmed the benefit of VCAP-AMP-VECP over CHOP. We conducted a retrospective analysis of transplant-eligible patients with ATL who received only VCAP-AMP-VECP or CHOP, incorporating inverse probability of treatment weighting (IPTW) using propensity scoring. Overall, 947 and 513 patients were treated with VCAP-AMP-VECP and CHOP, respectively. The median follow-up of surviving patients was 1006 days. The crude probabilities of 2-year overall survival (OS) for patients in the VCAP-AMP-VECP and CHOP groups were 31.2% and 24.6%, respectively (P < 0.001). Stratified by risk group according to the modified ATL-prognostic index score at diagnosis, the crude probabilities of 2-year OS in the VCAP-AMP-VECP and CHOP groups were 39.8 and 45.0% in the low-risk group (P = 0.69), 32.2 and 21.6% in the intermediate-risk group (P < 0.001), and 17.2 and 6.2% in the high-risk group (P = 0.005). Our current analysis suggests that VCAP-AMP-VECP regimen is a preferable front-line therapy in patients with aggressive ATL in intermediate- and high-risk groups.
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S.F., T.Y., Y.I., and T.F. participated in research design, data analysis, and manuscript writing. A.U., Y.M., S.O., T.M., Y.S., E.O., and S.Y. gathered the data. All authors approved the submission of this manuscript.
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S.F. received honoraria from the Kyowa Hakko Kirin Co., Ltd.; T.Y. had ownership interests of Statcom Co., Ltd., received consulting fees from Ono Pharmaceutical Co., Ltd., honoraria from Taiho Pharmaceutical Co., Ltd., and research funding from Kyowa Hakko Kirin Co., Ltd.; and A.U. received honoraria from Kyowa Hakko Kirin, Daiichi Sankyo, Siemens, Bristol-Myers Squibb, Pfizer, Novartis Pharma, Nippon Shinyaku, Mundi Pharma, Chugai Pharma, Ono Pharmaceutical CO, Eisai, Celgene, JIMRO, and Otsuka Pharmaceutical.
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Fuji, S., Yamaguchi, T., Inoue, Y. et al. VCAP-AMP-VECP as a preferable induction chemotherapy in transplant-eligible patients with aggressive adult T-cell leukemia-lymphoma: a propensity score analysis. Bone Marrow Transplant 54, 1399–1405 (2019). https://doi.org/10.1038/s41409-019-0446-z
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DOI: https://doi.org/10.1038/s41409-019-0446-z
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