A critical analysis of prognostic factors in North American patients with human T‐cell lymphotropic virus type‐1‐associated adult T‐cell leukemia/lymphoma

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. Cancer 2010. © 2010 American Cancer Society.