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  • Meeting abstract
  • Open Access

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

  • 1Email author,
  • 1,
  • 2,
  • 2,
  • 2,
  • 3 and
  • 1
Retrovirology20118 (Suppl 1) :A53

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

  • Published:

Keywords

  • Overall Survival
  • Zidovudine
  • Median Overall Survival
  • Interferon Alpha
  • Load Reduction

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

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