Revised Adult T-Cell Leukemia-Lymphoma International Consensus Meeting Report
Revised Adult T-Cell Leukemia-Lymphoma International Consensus Meeting Report
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DOI：
10.1200/jco.18.00501
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发表时间：
2019-03-10
影响因子：
45.3
通讯作者：
Watanabe, Toshiki
中科院分区：
文献类型：
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作者：
Cook, Lucy B.;Fuji, Shigeo;Watanabe, Toshiki
目的成人T细胞白血病-淋巴瘤（ATL）是由人类嗜T淋巴细胞病毒1型慢性感染引起的一种成熟T细胞恶性肿瘤，临床特征和预后各异。ATL由于其多样化的临床特征、恶性细胞的多药耐药性、频繁的大肿瘤负荷、高钙血症和/或频繁的机会性感染而仍然是一种具有挑战性的疾病。2009年，我们发表了一份共识报告，定义了预后因素、临床亚类、治疗策略和反应标准。2009年共识报告已成为ATL临床试验的标准参考和临床管理指南。自上次共识以来，在对ATL的分子病理生理学和风险适应治疗方法的理解方面取得了进展。方法为了反映这些进展，ATL研究人员和临床医生于2017年3月在日本东京举行的第18届人类逆转录病毒学国际会议上共同参加了人类嗜T细胞病毒和相关逆转录病毒，审查当前临床实践的证据，并更新共识，重点关注皮肤ATL的亚型分类、侵袭性ATL中的CNS病变、老年或不适合移植的患者的管理，和治疗策略，包括前期异基因造血干细胞移植和新的药物。结果由于低质量的临床证据，采用了最佳做法，共同作者商定了协商一致声明结论专家共识强调需要更多的临床试验来开发治疗AT的新的标准疗法
PurposeAdult T-cell leukemia-lymphoma (ATL) is a distinct mature T-cell malignancy caused by chronic infection with human T-lymphotropic virus type 1 with diverse clinical features and prognosis. ATL remains a challenging disease as a result of its diverse clinical features, multidrug resistance of malignant cells, frequent large tumor burden, hypercalcemia, and/or frequent opportunistic infection. In 2009, we published a consensus report to define prognostic factors, clinical subclassifications, treatment strategies, and response criteria. The 2009 consensus report has become the standard reference for clinical trials in ATL and a guide for clinical management. Since the last consensus there has been progress in the understanding of the molecular pathophysiology of ATL and risk-adapted treatment approaches.MethodsReflecting these advances, ATL researchers and clinicians joined together at the 18th International Conference on Human RetrovirologyHuman T-Lymphotropic Virus and Related Retrovirusesin Tokyo, Japan, March, 2017, to review evidence for current clinical practice and to update the consensus with a new focus on the subtype classification of cutaneous ATL, CNS lesions in aggressive ATL, management of elderly or transplantation-ineligible patients, and treatment strategies that incorporate up-front allogeneic hematopoietic stem-cell transplantation and novel agents.ResultsAs a result of lower-quality clinical evidence, a best practice approach was adopted and consensus statements agreed on by coauthors (> 90% agreement).ConclusionThis expert consensus highlights the need for additional clinical trials to develop novel standard therapies for the treatment of AT