Adult T-cell leukemia medical therapy: Difference between revisions
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===Management of Adult T-cell Lymphoma=== | ===Management of Adult T-cell Lymphoma=== | ||
* The first line chemotherapeutic regimens used for the initial management of adult T-cell leukemia include: | * The first line chemotherapeutic regimens used for the initial management of adult T-cell leukemia include: | ||
:* Cyclophosphamide {{and}} doxorubicin {{and}} vincristine {{and}} prednisone (CHOP) | :* [[Cyclophosphamide]] {{and}} [[doxorubicin]] {{and}} [[vincristine]] {{and}} [[prednisone]] (CHOP) | ||
:* Cyclophosphamide {{and}} doxorubicin {{and}} vincristine {{and}} etoposide {{and}} prednisone (CHOEP) | :* Cyclophosphamide {{and}} doxorubicin {{and}} vincristine {{and}} [[etoposide]] {{and}} prednisone (CHOEP) | ||
:* Etoposide {{and}} prednisone {{and}} vincristine {{and}} cyclophosphamide {{and}} doxorubicin (Dose-adjusted EPOCH) | :* Etoposide {{and}} prednisone {{and}} vincristine {{and}} cyclophosphamide {{and}} doxorubicin (Dose-adjusted EPOCH) | ||
:* Cyclophosphamide {{and}} vincristine {{and}} doxorubicin {{and}} dexamethasone (HyperCVAD) alternating with high-dose methotrexate and cytarabine | :* Cyclophosphamide {{and}} vincristine {{and}} doxorubicin {{and}} [[dexamethasone]] (HyperCVAD) alternating with high-dose [[methotrexate]] and [[cytarabine]] | ||
* Consider allogeneic stem cell transplantion for patients who respond to first line chemotherapeutic agents. | * Consider allogeneic [[stem cell]] transplantion for patients who respond to first line chemotherapeutic agents. | ||
* Patients who do not respond to the initial chemotherapeutic regimens may be managed by other second line chemotherapeutic agents such as: | * Patients who do not respond to the initial chemotherapeutic regimens may be managed by other second line chemotherapeutic agents such as: | ||
:* Bendamustine | :* [[Bendamustine]] | ||
:* Belinostat | :* [[Belinostat]] | ||
:* DHAP ([[dexamethasone]] {{and}} [[cisplatin]] {{and}} [[cytarabine]]) | |||
:* DHAP (dexamethasone | :* ESHAP ([[etoposide]] {{and}} [[methylprednisolone]] {{and}} [[cytarabine]] {{and}} | ||
:* ESHAP (etoposide {{and}} methylprednisolone {{and}} cytarabine {{and}} | :* GDP ([[gemcitabine]] {{and}} [[dexamethasone]] {{and}} [[cisplatin]]) | ||
:* GemOx (gemcitabine {{and}} [[oxaliplatin]]) | |||
:* GDP (gemcitabine {{and}} dexamethasone {{and}} cisplatin) | :* ICE (ifosfamide {{and}} [[carboplatin]] {{and}} [[etoposide]]) | ||
:* GemOx (gemcitabine {{and}} oxaliplatin) | |||
:* ICE (ifosfamide {{and}} carboplatin {{and}} etoposide) | |||
:* Pralatrexated | :* Pralatrexated | ||
:* Romidepsin | :* Romidepsin | ||
* Consider allogeneic stem cell transplantion for patients who respond to second line chemotherapeutic agents. | * Consider allogeneic stem cell transplantion for patients who respond to second line chemotherapeutic agents. | ||
==Supportive Therapy== | ==Supportive Therapy== | ||
===Opportunistic Infections Prophylaxis=== | ===Opportunistic Infections Prophylaxis=== | ||
Revision as of 22:18, 25 January 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
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 zidovudine 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. While adult T-cell lymphoma patients are usually managed by either chemotherapy, supportive care, or allogeneic stem cell transplant.[1]
Medical Therapy
- 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 zidovudine 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.
Management of Chronic/Smoldering Adult T-cell Leukemia
- 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)
- Local radiotherapy (8–36 Gy)
- Topical retinoids (bexarotene, tazarotene)
- Phototherapy (UVB, NB-UVB for management of patch/thin plaques; PUVA for management of 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.
- PatiLink titleents who responded to the therapy should be continued on zidovudine and interferon therapy.
- While patients who did not respond to the therapy should be managed by either chemotherapy or supportive care depending on the patients preference.
- The criteria for complete remission of adult T-cell leukemia patients includes:
- Absence of lymphadenopathy
- Absence of hepatomegaly and splenomegaly
- Absence of cutaneous lesions
- Absence of malignant cells on peripheral blood smear
- Absence of malignant cells on bone marrow biopsy
Management of Acute Adult T-cell Leukemia
- The first line chemotherapeutic regimens used for the initial management of adult T-cell leukemia include:
- Cyclophosphamide AND doxorubicin AND vincristine AND prednisone (CHOP)
- Cyclophosphamide AND doxorubicin AND vincristine AND etoposide AND prednisone (CHOEP)
- Etoposide AND prednisone AND vincristine AND cyclophosphamide AND doxorubicin (Dose-adjusted EPOCH)
- Cyclophosphamide AND vincristine AND doxorubicin AND dexamethasone (HyperCVAD) alternating with high-dose methotrexate and cytarabine
- Consider allogeneic stem cell transplantion for patients who respond to first line chemotherapeutic agents.
- Patients who do not respond to the initial chemotherapeutic regimens may be managed by other second line chemotherapeutic agents such as:
- Bendamustine
- Belinostat
- DHAP (dexamethasone AND cisplatin AND cytarabine)
- ESHAP (etoposide AND methylprednisolone AND cytarabine AND
- GDP (gemcitabine AND dexamethasone AND cisplatin)
- GemOx (gemcitabine AND oxaliplatin)
- ICE (ifosfamide AND carboplatin AND etoposide)
- Pralatrexated
- Romidepsin
- Consider allogeneic stem cell transplantion for patients who respond to second line chemotherapeutic agents.
- 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.
- Patients who responded to the therapy may be further managed by either allogeneic stem cell transplantion or continue on zidovudine and interferon combination therapy.
- While patients who did not respond to the therapy should be managed by either chemotherapy or supportive care depending on the patients preference.
Management of Adult T-cell Lymphoma
- The first line chemotherapeutic regimens used for the initial management of adult T-cell leukemia include:
- Cyclophosphamide AND doxorubicin AND vincristine AND prednisone (CHOP)
- Cyclophosphamide AND doxorubicin AND vincristine AND etoposide AND prednisone (CHOEP)
- Etoposide AND prednisone AND vincristine AND cyclophosphamide AND doxorubicin (Dose-adjusted EPOCH)
- Cyclophosphamide AND vincristine AND doxorubicin AND dexamethasone (HyperCVAD) alternating with high-dose methotrexate and cytarabine
- Consider allogeneic stem cell transplantion for patients who respond to first line chemotherapeutic agents.
- Patients who do not respond to the initial chemotherapeutic regimens may be managed by other second line chemotherapeutic agents such as:
- Bendamustine
- Belinostat
- DHAP (dexamethasone AND cisplatin AND cytarabine)
- ESHAP (etoposide AND methylprednisolone AND cytarabine AND
- GDP (gemcitabine AND dexamethasone AND cisplatin)
- GemOx (gemcitabine AND oxaliplatin)
- ICE (ifosfamide AND carboplatin AND etoposide)
- Pralatrexated
- Romidepsin
- Consider allogeneic stem cell transplantion for patients who respond to second line chemotherapeutic agents.
Supportive Therapy
Opportunistic Infections Prophylaxis
- Sulfamethoxazole/trimethoprim prophylaxis is recommended among adult T-cell leukemia patients to protect against opportunistic infections.
References
- ↑ Adult T-Cell Leukemia/Lymphoma. NCCN Guidelines Version 2 (2015) http://www.nccn.org/professionals/physician_gls/PDF/nhl.pdf Accessed on January, 25 2016