Mogamulizumab Concentration-guided Allogeneic Transplantation and Successful Intrathecal Chemotherapy for Central Nervous System-relapsed Adult T-cell Leukemia/Lymphoma

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Adult T-cell leukemia/lymphoma (ATL) has a poor prognosis, with mogamulizumab effectively controlling the disease but increasing graft-versus-host disease (GVHD) risk during transplantation if residual levels persist. We herein report a 61-year-old patient with acute-type ATL who underwent mogamulizumab concentration-guided transplantation to avoid severe GVHD despite human leukocyte antigen-mismatched donor transplantation. Post-transplant central nervous system (CNS) relapse was successfully managed with intrathecal chemotherapy alone, achieving long-term remission. Two years post-transplantation, the patient remains in complete remission without relapse or chronic GVHD. This case highlights the importance of assessing mogamulizumab levels for optimal transplantation timing and intrathecal chemotherapy as a strategy for CNS-limited ATL relapse.

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