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This article is part of the supplement: 15th International Conference on Human Retroviruses: HTLV and Related Viruses

Open Access Meeting abstract

Arsenic trioxyde in the treatment of HTLV1 associated ATLL

Felipe Suarez1*, Ambroise Marcais1, David Ghez2, Richard Delarue1, Benedicte Deau-Fischer1, Charbel Aoun1, Flore Sicre de Fontbrune1, Laurent Ysebaert3, Vahid Asnafi4, Daniele Canioni5, Hugue deThe6, Ali Bazarbachi7 and Olivier Hermine8*

Author Affiliations

1 Hématologie Adultes, Groupe Hospitalier Necker - Enfants malades, Paris, France

2 Hématologie Clinique, Institut Gustave Roussy, Villejuif, France

3 Hématologie, CHU Purpan, Toulouse, France

4 Hématologie Biologique, Groupe Hospitalier Necker - Enfants malades, Paris, France

5 Anatomie Pathologique, Groupe Hospitalier Necker - Enfants malades, Paris, France

6 CNRS Hôpital saint Louis, Paris , France

7 Hematology - Internal Medicine, American University Hospital, Beyrout, Liban

8 Hématologie Adultes et Cnrs Umr 8147, Groupe Hospitalier Necker - Enfants malades, Paris, France

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Retrovirology 2011, 8(Suppl 1):A59  doi:10.1186/1742-4690-8-S1-A59

The electronic version of this article is the complete one and can be found online at: http://www.retrovirology.com/content/8/S1/A59


Published:6 June 2011

© 2011 Suarez et al; licensee 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.

Background

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.

Patients and methods

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

Results

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).

Conclusion

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.