Combination of skin-directed therapy and oral etoposide for smoldering adult T-cell leukemia/lymphoma with skin involvement

• Published in: Leukemia & lymphoma 2013-03, Vol.54 (3), p.520-527
• Main Authors: Sawada, Yu, Shimauchi, Takatoshi, Yamaguchi, Takashi, Okura, Risa, Hama-Yamamoto, Kayo, Fueki-Yoshioka, Haruna, Ohmori, Shun, Yamada, Shigenori, Yoshizawa, Mayuko, Hiromasa, Kana, Tajiri, Makiko, Kabashima-Kubo, Rieko, Yoshioka, Manabu, Sugita, Kazunari, Yoshiki, Ryutaro, Hino, Ryosuke, Kobayashi, Miwa, Izu, Kunio, Nakamura, Motonobu, Tokura, Yoshiki
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; chemotherapeutic approaches; Combined Modality Therapy; Drug Administration Schedule; Etoposide - administration & dosage; Etoposide - adverse effects; Fatigue - etiology; Female; Humans; Kaplan-Meier Estimate; Leukemia-Lymphoma, Adult T-Cell - pathology; Leukemia-Lymphoma, Adult T-Cell - therapy; Leukopenia - etiology; lymphoid leukemia; Lymphoma and Hodgkin disease; Male; Middle Aged; Multivariate Analysis; Outcome Assessment (Health Care) - statistics & numerical data; Prednisolone - administration & dosage; Prednisolone - adverse effects; Proportional Hazards Models; Retrospective Studies; Skin - pathology; Skin - radiation effects; Ultraviolet Therapy - adverse effects; Ultraviolet Therapy - methods; Vomiting - etiology
• ISSN: 1042-8194; 1029-2403
• DOI: 10.3109/10428194.2012.715351

Abstract Approximately 50% of patients with adult T-cell leukemia/lymphoma (ATLL) have skin involvement, and the smoldering, skin lesion-bearing cases are often treated with various skin-directed therapies, such as phototherapy and radiation therapy. Daily oral administration of etoposide plus prednisolone (EP) is also used for smoldering-type ATLL. However, it remains unclear whether these therapies improve patients' survival. We retrospectively analyzed the prognosis of patients with smoldering, skin lesion-bearing ATLL (n = 62), who were treated, as first therapy, with one skin-directed therapy (n = 29), oral EP alone (n = 14) or a combination of skin-directed therapy and oral EP (n = 19). Multivariate analysis revealed that the hazard ratios (HRs) for the overall survival (OS) and progression-free survival (PFS) with the combination therapy were significantly lower than those with the skin-directed therapy (HR 0.1, p = 0.001; HR 0.2, p = 0.002, respectively). These results suggest that the combination of skin-directed therapy and oral EP improves the clinical outcome of patients with smoldering, skin lesion-bearing ATLL.