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EFS, event-free survival; F/U, follow-up; PFS, progression-free survival; IFN, interferon; AZT, zidovudine.

aIncludes one smouldering subtype; bincludes two chronic subtypes; call six nonresponders did not survive for >1 month; d at the time of study, 8 of 15 patients were in CR or PR; therefore, 10 of 15 patients achieved or maintained a response on AZT and IFN (but no further details provided); e 3 of these patients had been previously reported (Refs. 84 and 85).

proliferation and induce apoptosis.101-103 A synergistic effect is achieved when arsenic is combined with interferon alpha, leading to G1 cell cycle arrest, inhibition of cell proliferation, and induction of apoptosis.101

A phase II study assessed the efficacy of combination therapy with arsenic trioxide and interferon alpha in seven patients with relapsed or refractory ATL (four acute and three lymphoma).92 Median age was 46 years (range 28-56 years). None of the patients completed the planned treatment because of toxicity (n = 3) or disease progression (n = 4). Median treatment duration of arsenic trioxide was 22 days (range 17-28 days) and 21 days (range 4-28 days) for interferon alpha. Overall response was 57% (CR 14%; PR 43%). Progression-free survival was 1.5 months (range <1-32+ months) with a median OS of 1.5 months (range 1-32+ months).

Experience with retinoids as a single agent or in combination with interferon alpha and zidovudine in patients with ATL has been limited. Less than 15 ATL patients have been treated,104-109 with only 1 patient with concomitant acute promyelocytic leukemia and smouldering ATL achieving a CR.104 It is unclear whether improved efficacy may be obtained on combining retinoids with chemotherapy or novel targeted therapies.

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