Treatment of Acute or Lymphoma-Type Adult T-Cell Leukemia-Lymphoma with Bulky Lesions

This protocol covers the management of adult T-cell leukemia-lymphoma (ATLL) specifically in patients presenting with bulky lesions — whether in the acute subtype or the lymphoma-type subtype. Bulk significantly shapes the treatment pathway in this setting.

Clinical Scenario

Patients with acute adult T-cell leukaemia-lymphoma or lymphoma-type ATLL who have bulky lesions represent a distinct sub-population requiring a tailored approach. The presence of bulky disease is a defining feature of this protocol's scope.

Treatment Approach (Partial Overview)

In the relapsed or refractory setting, management may involve a second-line platinum-based regimen, with further selection guided by tumour marker profile. Allogeneic stem-cell transplantation is considered for eligible responding patients under specific conditions. The complete regimen — including sequencing, agent selection criteria, and eligibility thresholds — is available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2025.01.023

Patients with acute or lymphoma-type ATLL with bulky lesions may receive intensive combination ChT [e.g. CHOP, CHOEP or hyperfractionated cyclophosphamide-vincristine-doxorubicin-dexamethasone-MTX-cytarabine (hyper-CVAD)] with or without concurrent or sequential zidovudine-IFN-a (if tolerated) [III, C; not EMA or FDA approved].
A second-line platinum-based regimen can be considered [IV, B].
Monotherapy with mogamulizumab (if CCR4-positive; not EMA or FDA approved), BV (if CD30-positive; not EMA or FDA approved), alemtuzumab (if CD52-positive; not EMA or FDA approved) or lenalidomide (not EMA or FDA approved) can be considered [III, B].
Allo-HSCT (if not used in first line) should be considered in HSCT-eligible responding patients [III, A].

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