Allogeneic hematopoietic stem cell transplantation for adult T-cell leukemia/lymphoma with HTLV-1-associated myelopathy

Int J Hematol. 2021 May;113(5):765-769. doi: 10.1007/s12185-020-03075-6. Epub 2021 Jan 10.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) can be curative for adult T-cell leukemia/lymphoma (ATL), but comorbidities increase transplant-related mortality. Here we report the outcome of allo-HSCT in a patient with ATL with human T-cell leukemia virus type I (HTLV-1)-associated myelopathy-tropical spastic paraparesis (HAM/TSP). A 48-year-old man was diagnosed with HAM/TSP and started prednisolone therapy. Ten years later, he developed lymphoma-type ATL. At the diagnosis of ATL, Osame's Motor Disability Score (OMDS) was 4. When prednisolone was gradually tapered and stopped following chemotherapy for ATL, HAM/TSP symptoms recurred (OMDS 7). Bone marrow transplantation from a human leukocyte antigen allele 8/8 matched unrelated donor was performed while ATL was in partial remission. Neutrophil engraftment with complete donor chimerism was achieved on day 19 after allo-HSCT. Mild gait improvement (OMDS 5) was observed on day 30. Although ATL relapsed on day 275, progression of HAM/TSP symptoms was not observed. Furthermore, there was no clear progression of HAM/TSP symptoms after donor lymphocyte infusions. The outcome of this case suggests that ATL patients with HAM/TSP tolerate allo-HSCT and donor lymphocyte infusions.

Keywords: Adult T-cell leukemia/lymphoma; Allogeneic hematopoietic stem cell transplantation; HTLV-1-associated myelopathy.

Publication types

  • Case Reports

MeSH terms

  • HTLV-I Infections / complications*
  • Hematopoietic Stem Cell Transplantation*
  • Human T-lymphotropic virus 1 / isolation & purification
  • Humans
  • Leukemia-Lymphoma, Adult T-Cell / complications*
  • Leukemia-Lymphoma, Adult T-Cell / therapy*
  • Male
  • Middle Aged
  • Spinal Cord Diseases / complications*
  • Spinal Cord Diseases / virology
  • Transplantation, Homologous
  • Treatment Outcome