First line treatment of acute and chronic ATLL with zidovudine (AZT) and interferon alpha (IFN-α): haematological and molecular responses
© Hodson et al; licensee BioMed Central Ltd. 2011
Published: 6 June 2011
Recent data suggest an important role of zidovudine (ZDV) and interferon-α (IFN-α) in improving response rates and survival in acute ATLL. Treatment of chronic ATLL with ZDV/IFN-α alone has recently been associated with 100% survival beyond five years.
Retrospective analysis of patients with acute and chronic ATLL treated with ZDV/IFN-α first line. Response was assessed one month from the start of treatment using total lymphocyte and CD4 count, HTLV-1 proviral load (PVL) and clonal analysis (in house method).
Acute ATLL: response rate 33% (1 CR, 2 PR). Median overall survival (OS) 3 months (range 3-8).
Chronic ATLL: response rate 100% (4 CR, 1 PR). Median OS 20 months (range 9-73). In chronic ATLL these prolonged responses were observed despite lower dose therapy. Two patients, showed 10-fold reductions in PVL which occurred more than 1 year after haematological CR. All patients remain in remission at time of analysis. Clonality studies demonstrated a dominant clone at base line with emergence of a polyclonal pattern after viral load reduction.
The complete response in one patient with acute ATLL supports the recent observation that ZDV/IFN-α is effective as first line treatment in some patients.
The significant reduction in PVL and late emergence of a polyclonal integration pattern suggest benefit from prolonged ZDV/IFN-a therapy in chronic ATLL and the utility of both PVL and clonal analysis as a test of the efficacy of novel treatment regimes.
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