Topics:
Hematologic Malignancies • Medical Oncology • Bone Marrow Transplant • Lymphoma • NCI-CCC Tumor Board Question • Hematology • Memorial Sloan Kettering • NCI-CCC Lymphoma Tumor Board Question
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?
Answer from: Medical Oncologist at Academic Institution
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 whic...
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