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Transplant-related complications are impediments to the success of allogeneic hematopoietic stem cell transplantation for adult T cell leukemia patients in non-complete remission

Bone Marrow Transplantation volume 55, pages 233–241 (2020)Cite this article

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Abstract

Outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with adult T cell leukemia/lymphoma (ATL) are not satisfactory, particularly in patients in non-complete remission at transplantation (Pt-non-CR). We conducted a regional retrospective study in the ATL endemic area of Okinawa, Japan. Of 62 ATL patients, 21 received allo-HSCT in CR and 41 in non-CR. The 3-year overall survival (3yOS) rate and median survival time for the whole cohort was 25.6% and 7.7 months, respectively. The 3yOS of Pt-non-CR was significantly lower than that of patients in CR (Pt-CR) (16.8% vs. 43.6%, P = 0.005). Transplant-related mortality (TRM) was significantly higher in Pt-non-CR than in Pt-CR (46.3% vs. 15.7%, P = 0.025), while there was no significant difference in disease-associated mortality (DAM) between Pt-non-CR and Pt-CR. Multivariable analysis for Pt-non-CR revealed that poor performance status (poor-PS) and higher sIL-2R level (high sIL-2R) adversely affected OS. Poor-PS was associated with higher TRM, but not with higher DAM in Pt-non-CR. High sIL-2R did not affect TRM or DAM in Pt-non-CR. Overall, high TRM rates rather than DAM contribute to the poor outcomes of Pt-non-CR, suggesting that not only disease control but also management of transplant-related complications is required for allo-HSCT in ATL patients.

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Acknowledgements

The authors thank Masumi Shimoji for technical assistance with data management. This work was supported by JSPS KAKENHI Grant Number 17K09934 and MEXT KAKENHI Grant Number 17H05797 to SM.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan

    Shouhei Tomori, Satoko Morishima, Yukiko Nishi, Sawako Nakachi, Keita Tamaki, Kazuho Morichika, Iori Tedokon, Natsuki Shimabukuro, Taeko Hanashiro, Sakiko Kitamura, Sachie Uchibori, Riko Miyagi & Hiroaki Masuzaki

  2. Department of Hematology, Heartlife Hospital, Nakagusuku, Okinawa, Japan

    Takashi Miyagi, Kaori Karimata, Masayo Ohama & Atsushi Yamanoha

  3. Department of Hematology, Okinawa Prefectual Nambu Medical Center and Childrenʼs Medical Center, Haebaru, Okinawa, Japan

    Takeaki Tomoyose

  4. Departments of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Nishihara, Japan

    Kennosuke Karube

  5. Laboratory of Hematoimmunology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan

    Takuya Fukushima

Authors
  1. Shouhei Tomori
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  2. Satoko Morishima
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  3. Yukiko Nishi
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  4. Sawako Nakachi
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  12. Riko Miyagi
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  13. Takashi Miyagi
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  20. Hiroaki Masuzaki
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Contributions

ST, SM, YN, and HM participated in the design of the study; ST, SM, YN, SN, KT, KM, IT, NS, TH, SK, SU, RM, TM, K.Karimata, MO, AY, TT, K.Karube, and TF collected clinical data; ST and SM performed statistical data analysis; and ST, SM, and HM wrote the paper. All authors checked the final version of the paper.

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Correspondence to Satoko Morishima.

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Tomori, S., Morishima, S., Nishi, Y. et al. Transplant-related complications are impediments to the success of allogeneic hematopoietic stem cell transplantation for adult T cell leukemia patients in non-complete remission. Bone Marrow Transplant 55, 233–241 (2020). https://doi.org/10.1038/s41409-019-0669-z

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