Interferon alpha and zidovudine therapy in adult T-cell leukaemia lymphoma: response and outcome in 15 patients

Adult T-cell leukaemia lymphoma (ATLL) is an aggressive disease caused by t he human T-lymphotropic virus 1 (HTLV-I) with a short survival, Responses t o interferon alpha (IFN-alpha) and zidovudine (AZT) have been documented bu t not with long-term follow-up. We treated 15 ATLL, patients with IFN and A ZT. Eleven patients had acute ATLL, two had lymphoma and two smouldering AT LL, with progression. The main features were: organomegaly (14), skin lesio ns (10), high white blood cell (WBC) count (11) and hypercalcaemia (9). Ele ven patients had previously received chemotherapy and one had received an a utograft. Al the time of the study, seven patients had progressive disease and eight were in partial or complete clinical remission. Responses (PR) la sting 2+ to 44+ months were seen in 67%; 26% did not respond (NR) and one p atient was not evaluable. Hypercalcaemia predicted a poor outcome but diffe rences were not significant. Eight of the 15 patients have died 3-41 months from diagnosis. Median survival for the 15 patients was 18 months. Surviva l of the NR ranged from 4 to 20 months; six PR patients are alive 8-82 mont hs from diagnosis. The differences in survival between NR (median: 6 months ) and PR (55% of patients alive at 4 years) were statistically significant (P = 0.002). In conclusion, IFN and AZT improves the outcome of ATLL patien ts and helps maintain responses.