The effect of chemotherapy dose intensity on outcomes for patients with aggressive adult T-cell leukemia/lymphoma

This study aimed to investigate the effect of chemotherapy dose intensity on outcomes for patients with adult T-cell leukemia/lymphoma.  This study concluded that higher chemotherapy dose intensity improves outcomes for these patients. 

Adult T-cell leukemia/lymphoma (ATL) is an aggressive blood cancer. It can be found in the blood (leukemia), the lymph nodes (lymphoma), and other tissues of the body. It has been associated with an infection with the human T-cell lymphotropic virus type 1 (HTLV-1) and commonly has a poor prognosis. It is commonly treated with chemotherapy.

Dose intensity is the amount of drug given in a fixed unit of time. In other types of lymphoma such as diffuse large B cell lymphoma (DLBCL), higher chemotherapy doses have been associated with better survival. However, it was unknown if chemotherapy dose intensity affects outcomes for patients with ATL. 

This study involved 312 patients with aggressive ATL. The effect of chemotherapy dose intensity on outcomes for these patients was studied. 62 patients underwent best supportive care (BSC) or single-agent chemotherapy as first-line treatment. 235 underwent intensive chemotherapy (IC) as first-line treatment.  

The average survival time was 0.58 years overall. 23.7% of all patients were alive after 2 years. The average survival was significantly higher in the IC group (0.75 years) compared to the BSC/single-agent group (0.13 years).  

Patients in the IC group were treated with either CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP-like regimens or VCAP (vincristine, cyclophosphamide, doxorubicin, and prednisone)-AMP (doxorubicin, ranimustine, and prednisone)-VECP (vindesine, etoposide, carboplatin, and prednisone). Patients treated with VCAP-AMP-VECP had better survival compared to those treated with CHOP/CHOP-like regimens (1.21 years vs 0.6 years). 

The average relative dose intensity (ARDI) of patients in the IC group was 60%. Patients were divided into groups based on ARDI. Patients who had ARDI of 75% and over (high intensity), had better survival when compared to those who had ARDI of 45% or less (low intensity). Patients with high ARDI had an average survival time of 4.69 years compared to 0.75 years for those who had ARDI of 45% or less. Both ARDI groups had a similar occurrence of organ dysfunction and infectious complications. 

This study concluded that higher dose intensity chemotherapy leads to better outcomes in patients with aggressive ATL when compared to lower dose intensity.  

This study was based on data from medical records. Some information such as the reason for choosing a certain dose intensity was not available.