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Successful treatment of a patient with adult T-cell leukemia by daily oral administration of low-dose etoposide.
Background:
Oral administration of low-dose etoposide is known to be effective against various malignancies, including malignant lymphoma. However, the effectiveness of low-dose etoposide as a treatment for adult T-cell leukemia (ATL) has not been established.
Methods:
A 74-year-old woman with ATL in acute phase was treated by daily oral administration of low-dose etoposide (25 mg/m2). The authors assayed changes in the surface markers and the amount of human T-cell lymphotropic virus type I (HTLV-I) proviral DNA in peripheral blood mononuclear cells (PBMC) by using flow cytometry and the polymerase chain reaction (PCR) method, respectively.
Results:
Before treatment, generalized lymphadenopathy and hepatomegaly were observed. In laboratory examination, the leukocyte count was 13.7 x 10(3)/microliters, with 65% abnormal lymphocytes. The percentages of CD3-, CD4-, and CD25-positive cells in PBMC were 84.4%, 84.4%, and 76.5%, respectively. The serum lactic dehydrogenase (LDH) level was 1376 IU/l (normal range, less than 520 IU/l). After the initiation of treatment, lymph-adenopathy and hepatomegaly disappeared, and the serum LDH level was reduced to the normal level before the 20th day of the treatment. On the 55th day of the treatment, CD25-positive cells had virtually disappeared. In addition, the amount of the proviral DNA in PBMC was reduced to approximately one-tenth by this treatment. Subsequently, the patient was in remission for more than 16 months. No side effects were observed.
Conclusions:
Daily oral administration of low-dose etoposide can be a safe and effective treatment for patients with ATL. The authors believe this to be the first report of a patient with ATL in whom complete remission (CR) was achieved by this treatment.