[Prevention and treatment of post-transplant relapse in adult T-cell leukemia-lymphoma].

Abstract

Aggressive adult T-cell leukemia-lymphoma (ATL) is a rare T-cell malignancy with a poor prognosis. Allogeneic hematopoietic cell transplantation (allo-HCT) is a curative therapy, but the long-term survival rate is approximately 40%, which is poor compared to other hematopoietic tumors. The most common cause of death after allo-HCT is ATL relapse. Approximately 40% of patients experience a relapse following allo-HCT, and the prognosis after relapse remains poor. In recent years, various strategies have been attempted to prevent and treat post-transplant ATL relapse. Cord blood and HLA haplo-identical related donors are widely used as alternative donors to Japan Marrow Donor Program donors for transplantation in remission soon after diagnosis, and novel drugs for ATL are used as salvage therapy before or after allo-HCT. Monitoring of measurable residual disease with flow cytometry has also been attempted for early detection of post-transplant relapse. Nevertheless, there is still insufficient evidence for the prevention and treatment of post-transplant relapse of ATL. Given the limited experience at individual hospitals and the increasing population of HTLV-1 carriers throughout the country, it is desirable to build evidence based on treatment experience and analysis of clinical specimens from hospitals throughout Japan.