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Arsenic trioxyde in the treatment of HTLV1 associated ATLL


The prognosis of Adult T-cell leukemia/lymphoma (ATLL) associated with HTLV1 is dismal. The response to conventional chemotherapy ranges between 20 and 70% and relaspe is constant. Median survival is 8 to 13 months. Chronic and smouldering ATLL have a longer survival, ranging from 18 to 72 months at 5 years. Interferon alpha (IFNa) and AZT combination therapy is effective in acute, chronic and smouldering ATLL, sometimes leading to complete response and has a better prognosis than conventional chemotherapy (5 year survival of 82% in acute and 100% in chronic and smouldering forms reaching a complete response). Patients with ATLL/lymphoma do not benefit from IFNa+AZT combination and despite initial response to chemotherapy, all patients eventually relapse. Arsenic trioxyde (AsO3) in combination with IFNa has in vitro activity with a negative regulation of the Tax oncoprotein and leads to apoptosis of HTLV1 transformed lymphocytes. A recent study has showed a benefit in chronic forms of ATLL.

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11 patients with ATLL were treated with AsO3+IFN combination after a minimum of 1 line of treatment.


3 patients had ATLL/lymphoma, 3 chronic and 5 acute. All patients had recieved previous therapy with chemotherapy associated or not with IFNa/AZT combination. At initiation of AsO3, 4 patients were in complete response (3 lymphoma, 1 acute), 2 partial response (1 acute, 1 chronic) et 5 in progression (3 acute, 2 chronic). 10 patients recieved AsO3 during 3 to 8 weeks 1 patient progressed 3 days after starting AsO3. Tolerance was acceptable with peripheral neurolopathy (n = 4), hand and foot syndrome (n = 3) et drug eruption (n = 3 including 2 toxic epidermal necrolysis). 6 patients died, and all were progressing at time of AsO3 initiation. 5 patients survived : 3 lymphomas in complete response (25, 31 et 46 months follow-up), 1 acute in complete response (9 months follow-up) and 1 one chronic in partial response (39 months follow-up).


AsO3 and IFNa combination has an acceptable tolerance profile and seems to be effective in ATLL in consolidation after response to a previous treatment, particularly in lymphoma and chronic forms.

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Correspondence to Felipe Suarez.

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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 (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Suarez, F., Marcais, A., Ghez, D. et al. Arsenic trioxyde in the treatment of HTLV1 associated ATLL. Retrovirology 8 (Suppl 1), A59 (2011).

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