Patients with aggressive adult T-cell leukemia-lymphoma (ATL) have dismal outcomes with intensive chemotherapy. Early up-front allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally recommended. However, the choice of stem cell source, i.e., unrelated bone marrow transplant (UBMT) or cord blood transplantation (CBT), when an HLA-matched related donor is unavailable remains controversial. Thus, we undertook a decision analysis to compare the outcomes of two therapeutic strategies: chemotherapy followed by up-front UBMT at 6 months, and chemotherapy followed by up-front CBT at 3 months. Patients were stratified into low-, intermediate-, and high-risk groups according to the modified ATL-prognostic index. The model simulated life expectancy (LE) and quality-adjusted LE (QALE). LE following up-front UBMT was higher than that following up-front CBT in the low-risk group (2.63 vs. 2.28 years), but was comparable in the intermediate- (2.06 vs. 2.01 years) and high-risk groups (1.25 vs. 1.30 years). The Monte Carlo simulation for LE and QALE in each risk group showed that there was significant uncertainty in all categories. In conclusion, up-front UBMT was superior to up-front CBT in the low-risk group, but the strategies were comparable in the intermediate- and high-risk groups.

中文翻译：

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一项决策分析比较了侵略性成人T细胞白血病-淋巴瘤患者的无关骨髓移植和脐血移植。

患有侵袭性成人T细胞白血病-淋巴瘤（ATL）的患者在接受强力化疗后会出现令人沮丧的结果。通常建议早期的前期异基因造血干细胞移植（allo-HSCT）。然而，当无法获得HLA匹配的相关供体时，干细胞来源的选择，即不相关的骨髓移植（UBMT）或脐带血移植（CBT），仍存在争议。因此，我们进行了一项决策分析，以比较两种治疗策略的结果：化疗后6个月先行UBMT，化疗后3个月先行CBT。根据修改后的ATL预后指数将患者分为低，中和高风险组。该模型模拟了预期寿命（LE）和质量调整后的LE（QALE）。在低风险组中，先行UBMT后的LE高于在先行CBT后的LE（2.63对2.28年），但在中级（2.06对2.01年）和高风险组（1.25）相当与1.30年相比）。每个风险组中LE和QALE的蒙特卡洛模拟表明，所有类别中都存在明显的不确定性。总之，在低风险组中，前期UBMT优于前期CBT，但在中，高风险组中，策略可比。