TREATMENT FOR ADULT T-CELL LEUKEMIA

The purpose of this study was to clarify the clinical efficacy of mult idrug chemotherapy for aggressive adult T-cell leukemia (ATL). We repo rt the therapeutic results of treatment of patients with aggressive AT L undertaken between 1986 and 1995. A total of 120 newly diagnosed pat ients with a performance status of 0-3 and aged <70 years at diagnosis were entered into the study. Clinical features, including clinical su btypes, serum levels of lactate dehydrogenase and blood urea nitrogen, the response to chemotherapy, and doses of individual chemotherapeuti c agents, were evaluated. Of the 120 patients enrolled, 97 had acute-t ype and 23 lymphoma-type ATL. The complete response rate and median su rvival of these patients were 25.3% and 9 months, respectively. The 2- and 5-year survival rates were 18.4% and 8%, respectively, and five pa tients have been alive for >5 years and are disease free. These long-t erm survivors had good prognostic factors at diagnosis. There was no c orrelation between the doses of the various chemotherapeutic agents an d the survival duration. These results indicate that ordinary combined chemotherapy has limited ability to improve the prognosis of aggressi ve ATL. Our previous study indicated that expression of P-glycoprotein in ATL cells might be involved in resistance to chemotherapeutic agen ts, particularly doxorubicin, vincristine, and etoposide. Therefore, n ew therapeutic strategies will be necessary to improve the prognosis o f ATL patients.