Sandbox: ATL

• The optimal therapy for adult T-cell leukemia depends on the clinical variant of the disease.
• Chronic and smoldering adult T-cell leukemia patients are usually managed by either observation, skin directed therapies, or a combination of idovudine and interferon therapy.
• Acute adult T-cell leukemia patients are usually managed by either chemotherapy, supportive care, allogeneic stem cell transplant, or a combination of zidovudine and interferon therapy.
• Adult T-cell lymphoma patients are usually managed by either chemotherapy, supportive care, or allogeneic stem cell transplant.

Chronic/Smoldering Adult T-cell Leukemia Management

• Patients may be managed by observation and close follow-up for any symptomatic deterioration. Follow up tests for such patients may include:

• Complete history and physical examination
• Serum calcium level
• Blood urea nitrogen
• Serum creatinine level
• Serum LDH
• Chest and abdominal CT scan

• Skin directed therapies for the management of localized cutaneous lesions among such patients may include:

• Topical corticosteroids
• Topical chemotherapy (mechlorethamine [nitrogen mustard])
• Local radiation (8–36 Gy)
• Topical retinoids (bexarotene, tazarotene)
• Phototherapy (UVB, NB-UVB for patch/thin plaques; PUVA for thicker plaques)
• Topical imiquimod

• Zidovudine and interferon combination therapy:

• Chronic/smoldering adult T-cell leukemia patients should be evaluated for response after two months of initiating the combination therapy.
• Responders should be continued on zidovudine and interferon therapy.
• While non-responders should be managed by either chemotherapy or supportive care depending on the patients preference.