Volume 8 Supplement 1

15th International Conference on Human Retroviruses: HTLV and Related Viruses

Open Access

First line treatment of acute and chronic ATLL with zidovudine (AZT) and interferon alpha (IFN-α): haematological and molecular responses

  • Andrew Hodson1Email author,
  • Maria A Demontis1,
  • Nicolas Gillet2,
  • Lucy Cook2,
  • Charles R M Bangham2,
  • Paul Fields3 and
  • Graham P Taylor1
Retrovirology20118(Suppl 1):A53

https://doi.org/10.1186/1742-4690-8-S1-A53

Published: 6 June 2011

Introduction

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.

Methods

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).

Results

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.

Discussion

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.

Authors’ Affiliations

(1)
Section of Infectious Diseases, Wright-Fleming Institute, Imperial College London
(2)
Department of Immunology, Wright-Fleming Institute, Imperial College London
(3)
Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust

Copyright

© Hodson et al; licensee BioMed Central Ltd. 2011

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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