Staging page

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Guidelines

"How I Treat"

NCCN

Untreated

CHOP-14

CHOP-14: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne every 14 days
CHOP-DI: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne, Dose-Intense
I-CHOP: Intensive Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Predniso(lo)ne

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy Comparative Toxicity
Itoh et al. 2002 (JCOG 9505) 1995-1998 Randomized Phase 2 (E-de-esc) dose-escalated CHOP Did not meet primary endpoint of CR rate Less toxic
Tsukasaki et al. 2007 (JCOG 9801) 1998-2003 Phase 3 (C) mLSG15 Seems to have inferior CR rate Less toxic

Chemotherapy

Glucocorticoid therapy

Supportive therapy

  • Filgrastim (Neupogen) given once ANC decreased to less than 1000/uL and continued once per day until count increased to greater than 5000/uL

14-day cycle for 8 cycles

CNS therapy

Intrathecal triple-therapy was given during recovery phase of cycles 1, 3, and 5 after platelet count was greater than 70 × 109/L.

3 doses, total

References

  1. JCOG 9505: Itoh K, Ohtsu T, Fukuda H, Sasaki Y, Ogura M, Morishima Y, Chou T, Aikawa K, Uike N, Mizorogi F, Ohno T, Ikeda S, Sai T, Taniwaki M, Kawano F, Niimi M, Hotta T, Shimoyama M, Tobinai K; JCOG. Randomized phase II study of biweekly CHOP and dose-escalated CHOP with prophylactic use of lenograstim (glycosylated G-CSF) in aggressive non-Hodgkin's lymphoma: Japan Clinical Oncology Group Study 9505. Ann Oncol. 2002 Sep;13(9):1347-55. link to original article PubMed
  2. JCOG 9801: Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; JCOG. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains dosing details in manuscript PubMed NCT00145002

mLSG15

Regimen

Study Years of enrollment Evidence Comparator Comparative Efficacy
Tsukasaki et al. 2007 (JCOG 9801) 1998-2003 Phase 3 (E-esc) CHOP-14 Seems to have superior CR rate
Ishida et al. 2015 (Kyowa 0761-003) 2010-2011 Randomized Phase 2 (C) mLSG15 & Mogamulizumab Did not meet primary endpoint of CR rate

Ranimustine is not available in the United States and is approved only in Japan.

Chemotherapy

Glucocorticoid therapy

28-day cycle for 6 cycles

CNS therapy, prophylaxis

Given after cycles 1, 3, and 5 after platelets greater than 70 × 109/L and within 2 days before the next cycle

References

  1. JCOG 9801: Tsukasaki K, Utsunomiya A, Fukuda H, Shibata T, Fukushima T, Takatsuka Y, Ikeda S, Masuda M, Nagoshi H, Ueda R, Tamura K, Sano M, Momita S, Yamaguchi K, Kawano F, Hanada S, Tobinai K, Shimoyama M, Hotta T, Tomonaga M; JCOG. VCAP-AMP-VECP compared with biweekly CHOP for adult T-cell leukemia-lymphoma: Japan Clinical Oncology Group Study JCOG9801. J Clin Oncol. 2007 Dec 1;25(34):5458-64. Epub 2007 Oct 29. link to original article contains dosing details in manuscript PubMed NCT00145002
  2. Kyowa 0761-003: Ishida T, Jo T, Takemoto S, Suzushima H, Uozumi K, Yamamoto K, Uike N, Saburi Y, Nosaka K, Utsunomiya A, Tobinai K, Fujiwara H, Ishitsuka K, Yoshida S, Taira N, Moriuchi Y, Imada K, Miyamoto T, Akinaga S, Tomonaga M, Ueda R. Dose-intensified chemotherapy alone or in combination with mogamulizumab in newly diagnosed aggressive adult T-cell leukaemia-lymphoma: a randomized phase II study. Br J Haematol. 2015 Jun;169(5):672-82. Epub 2015 Mar 2. link to original article link to PMC article PubMed NCT01173887

Relapsed or refractory

Alemtuzumab monotherapy

Regimen

Study Years of enrollment Evidence
Sharma et al. 2016 2004-2009 Phase 2

Targeted therapy

7-day cycle for up to 7 cycles

References

  1. Sharma K, Janik JE, O'Mahony D, Stewart D, Pittaluga S, Stetler-Stevenson M, Jaffe ES, Raffeld M, Fleisher TA, Lee CC, Steinberg SM, Waldmann TA, Morris JC. Phase II study of alemtuzumab (CAMPATH-1) in patients with HTLV-1-associated adult T-cell leukemia/lymphoma. Clin Cancer Res. 2017 Jan 1;23(1):35-42. Epub 2016 Aug 2. link to original article contain protocol link to PMC article PubMed

Lenalidomide monotherapy

Regimen

Study Years of enrollment Evidence Efficacy
Ishida et al. 2016 (ATLL-002) 2012-2014 Phase 2 ORR: 42% (95% CI 23-63)

Targeted therapy

Continued indefinitely

References

  1. ATLL-002: Ishida T, Fujiwara H, Nosaka K, Taira N, Abe Y, Imaizumi Y, Moriuchi Y, Jo T, Ishizawa K, Tobinai K, Tsukasaki K, Ito S, Yoshimitsu M, Otsuka M, Ogura M, Midorikawa S, Ruiz W, Ohtsu T. Multicenter phase II study of lenalidomide in relapsed or recurrent adult T-cell leukemia/lymphoma: ATLL-002. J Clin Oncol. 2016 Dec;34(34):4086-4093. link to original article PubMed NCT01724177
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