What's the optimal management of stage IA nodal ATLL in a young fit patient?

Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >90%. There was HTLV viremia (15,000 copies) but PET revealed only stage I disease, albeit with local invasion of subcutaneous tissues and skeletal muscle. Bone marrow biopsy and CSF sampling were negative. The patient was started on EPOCH, and achieved a PET complete response after 2 cycles. How best to consolidate? RT, alloSCT (DUBCT), or RT+allo?

1 Answer

Mednet MemberInvited Expert

Medical Oncology · University of Maryland Cancer Center

Answered on

It is a difficult question to answer. More data is needed to give recommendations: LDH, Ca, circulating ATL, lymphocytosis, etc. as it will be useful to sub-categorize her disease as lymphoma-type vs. chronic-type (favorable or unfavorable). It looks like you are treating her as a lymphoma-type which I agree with. In this case, I suggest continuing a full course of EPOCH and restage her after. If no evidence of disease, I would be cautious before offering her radiation as her disease is in the neck. I would be sending HLA typing and try to find/secure a donor for her. Given the early stage disease, her young age, and the availability of decent salvage treatment (Moga, BV, etc), I would keep alloHSCT as a consolidation if and for 1st relapse...

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What's the optimal management of stage IA nodal ATLL in a young fit patient?

Would you recommend AlloHSCT in 1st remission for localized ATLL after EPOCH?