A critical analysis of prognostic factors in North American patients with human T-cell lymphotropic virus type-1-associated adult T-cell leukemia/lymphoma: A multicenter clinicopathologic experience and new prognostic score Journal Article


Authors: Phillips, A. A.; Shapira, I.; Willim, R. D.; Sanmugarajah, J.; Solomon, W. B.; Horwitz, S. M.; Savage, D. G.; Bhagat, G.; Soff, G.; Zain, J. M.; Alobeid, B.; Seshan, V. E.; O'Connor, O. A.
Article Title: A critical analysis of prognostic factors in North American patients with human T-cell lymphotropic virus type-1-associated adult T-cell leukemia/lymphoma: A multicenter clinicopathologic experience and new prognostic score
Abstract: BACKGROUND: To define the clinicopathologic and prognostic features of patients with human T-cell lymphotropic virus type-1 (HTLV-1)-associated adult T-cell leukemia/lymphoma (ATLL) in North America, standard criteria were used to identify patients with ATLL. METHODS: Statistical analyses used included descriptive statistics, Kaplan-Meir survival analysis, and recursive partitioning. RESULTS: Eighty-nine patients were identified between August 1992 and May 2007, including 37 (41.6%) males and 52 (58.4%) females with a median age of 50 years (range, 22-82 years). All but 6 patients had immigrated to the United States from the Caribbean, Latin America, or Africa. The acute subtype predominated (68.5%). The majority of patients received a combination-alkylator- based chemotherapy regimen in the front-line setting (72.6%). The most common regimen was cyclophosphamide, doxorubicin, vincristine, and prednisone at standard doses or attenuated and/or with methotrexate (CHOP-like), which produced an overall response rate of 64.1%. Despite initial responses to therapy, the median overall survival for all subtypes was 24 weeks (range, 0.9-315 weeks). Although the International Prognostic Index and Prognostic Index for peripheral T-cell lymphoma unspecified identified subsets of patients, these models were not completely predictive. A recursive partitioning analysis was performed on the data, which successfully identified 3 prognostic categories based on Eastern Cooperative Oncology Group performance status, stage, age, and calcium level at diagnosis. CONCLUSIONS: This series proposed a new prognostic model for patients with HTLV-1-associated ATLL and confirmed a poor outcome for these patients in North America. © 2010 American Cancer Society.
Keywords: adult; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; overall survival; fludarabine; prednisone; clinical feature; disease course; doxorubicin; interferon; cancer combination chemotherapy; united states; gemcitabine; cancer radiotherapy; cytarabine; methotrexate; cancer staging; drug megadose; lymphadenectomy; carboplatin; bortezomib; etoposide; antineoplastic combined chemotherapy protocols; cyclophosphamide; dexamethasone; vincristine; calcium blood level; chlormethine; ifosfamide; procarbazine; risk assessment; statistical analysis; prognostic factors; epirubicin; aging; idarubicin; kaplan meier method; statistical model; granulocyte colony stimulating factor; t cell leukemia; pralatrexate; alemtuzumab; chlorambucil; allotransplantation; north america; non-hodgkin lymphoma; zidovudine; human t cell leukemia virus 1; human t-lymphotropic virus 1; leukemia-lymphoma, adult t-cell; lamivudine; puva; denileukin diftitox; adult t-cell leukemia/lymphoma; human t-cell lymphotropic virus type-1 (htlv-1); bexarotene; psoralen
Journal Title: Cancer
Volume: 116
Issue: 14
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-07-15
Start Page: 3438
End Page: 3446
Language: English
DOI: 10.1002/cncr.25147
PUBMED: 20564100
PROVIDER: scopus
DOI/URL:
Notes: --- - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
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MSK Authors
  1. Steven M Horwitz
    351 Horwitz
  2. Gerald A Soff
    59 Soff