Abstract
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.
Similar content being viewed by others
References
Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, et al. VCAP–AMP–VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan clinical oncology group study JCOG9801. J Clin Oncol. 2007;25:5458–64.
Fukushima T, Nomura S, Shimoyama M, Shibata T, Imaizumi Y, Moriuchi Y, et al. Japan clinical oncology group (JCOG) prognostic index and characterization of long-term survivors of aggressive adult T-cell leukaemia-lymphoma (JCOG0902A). Br J Haematol. 2014;166:739–48.
Fuji S, Yamaguchi T, Inoue Y, Utsunomiya A, Moriuchi Y, Uchimaru K, et al. Development of a modified prognostic index of patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: a possible risk-adapted management strategies including allogeneic transplantation. Haematologica. 2017;102(7):1258–65.
Mehta-Shah N, Ratner L, Horwitz SM. Adult T-cell leukemia/lymphoma. J Oncol Pract. 2017;13:487–92.
Bazarbachi A, Cwynarski K, Boumendil A, Finel H, Fields P, Raj K, et al. Outcome of patients with HTLV-1-associated adult T-cell leukemia/lymphoma after SCT: a retrospective study by the EBMT LWP. Bone Marrow Transpl. 2014;49:1266–8.
Cook LB, Fuji S, Hermine O, Bazarbachi A, Ramos JC, Ratner L, et al. Revised adult T-cell leukemia-lymphoma international consensus meeting report. J Clin Oncol. 2019;37:677–87.
Hishizawa M, Kanda J, Utsunomiya A, Taniguchi S, Eto T, Moriuchi Y, et al. Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study. Blood. 2010;116:1369–76.
Malpica L, Pimentel A, Reis IM, Gotuzzo E, Lekakis L, Komanduri K, et al. Epidemiology, clinical features, and outcome of HTLV-1-related ATLL in an area of prevalence in the United States. Blood Adv. 2018;2:607–20.
Fukushima T, Itonaga H, Moriuchi Y, Yoshida S, Taguchi J, Imaizumi Y, et al. Feasibility of cord blood transplantation in chemosensitive adult T-cell leukemia/lymphoma: a retrospective analysis of the Nagasaki transplantation network. Int J Hematol. 2013;97:485–90.
Nakamura T, Oku E, Nomura K, Morishige S, Takata Y, Seki R, et al. Unrelated cord blood transplantation for patients with adult T-cell leukemia/lymphoma: experience at a single institute. Int J Hematol. 2012;96:657–63.
Koreth J, Pidala J, Perez WS, Deeg HJ, Garcia-Manero G, Malcovati L, et al. Role of reduced-intensity conditioning allogeneic hematopoietic stem-cell transplantation in older patients with de novo myelodysplastic syndromes: an international collaborative decision analysis. J Clin Oncol. 2013;31:2662–700.
Kurosawa S, Yamaguchi H, Yamaguchi T, Fukunaga K, Yui S, Wakita S, et al. Decision analysis of postremission therapy in cytogenetically intermediate-risk acute myeloid leukemia: the impact of FLT3 internal tandem duplication, nucleophosmin, and CCAAT/enhancer binding protein alpha. Biol Blood Marrow Transplant. 2016;22:1125–32.
Fuji S, Kurosawa S, Inamoto Y, Murata T, Utsunomiya A, Uchimaru K, 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 Transpl. 2018;53:905–8.
Fuji S, Inoue Y, Utsunomiya A, Moriuchi Y, Uchimaru K, Choi I, et al. Pretransplantation anti-CCR4 antibody mogamulizumab against adult T-Cell leukemia/lymphoma is associated with significantly increased risks of severe and corticosteroid-refractory graft-versus-host disease, nonrelapse mortality, and overall mortality. J Clin Oncol. 2016;34:3426–33.
Kurosawa S, Yamaguchi T, Miyawaki S, Uchida N, Kanamori H, Usuki K, et al. A Markov decision analysis of allogeneic hematopoietic cell transplantation versus chemotherapy in patients with acute myeloid leukemia in first remission. Blood. 2011;117:2113–200.
Kurosawa S, Oshima K, Yamaguchi T, Yanagisawa A, Fukuda T, Kanamori H, et al. Quality of life after allogeneic hematopoietic cell transplantation according to affected organ and severity of chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2017;23:1749–58.
Ciurea SO, Bittencourt MCB, Milton DR, Cao K, Kongtim P, Rondon G, et al. Is a matched unrelated donor search needed for all allogeneic transplant candidates? Blood Adv. 2018;2:2254–61.
Yanada M, Kanda J, Ohtake S, Fukuda T, Sakamaki H, Miyamura K, et al. Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission. Eur J Haematol. 2016;97:278–87.
Acknowledgements
This research was partially supported by the Practical Research for Innovative Cancer Control program of the Japan Agency for Medical Research and Development (19ck0106342h0003) and a National Cancer Research and Development Fund (29-A-14).
Author information
Authors and Affiliations
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 of the submission of this manuscript.
Corresponding author
Ethics declarations
Conflict of interest
S.F. received honoraria from Kyowa Hakko Kirin Co., Ltd.; T.M. is an employee of Crecon Medical Assessment Inc, Tokyo, Japan; A.U. 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; T.Y. had ownership interests in Statcom Co., Ltd., received consulting fees from Ono Pharmaceutical Co., Ltd., received honoraria from Taiho Pharmaceutical Co., Ltd., and received research funding from Kyowa Hakko Kirin Co., Ltd.; M.H. received research funding from Chugai Pharm Co., Ltd.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Fuji, S., Kurosawa, S., Inamoto, Y. et al. A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma. Int J Hematol 111, 427–433 (2020). https://doi.org/10.1007/s12185-019-02777-w
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12185-019-02777-w