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Advances have been made in transplant modalities, novel targeted agents and supportive care; however, it remains unclear whether these advances have improved survival outcomes of post\u2010transplant R\/R ATL. To clarify changes in survival after post\u2010transplant R\/R, we evaluated the survival outcomes in 1146 patients over a 24\u2010year period, using a nationwide database. The period was divided into three groups: 1999\u20132010 (early period, as reference), 2011\u20132016 (middle period) and 2017\u20132022 (late period). In patients with refractory ATL, multivariate analyses showed no significant difference in overall mortality (OM) after post\u2010transplant refractory in the early and middle periods, but a significantly lower OM in the late period than in the early period (hazard ratio [HR], 0.73 [95% confidence interval, 0.55\u20130.96]). In patients with relapsed ATL, OM after post\u2010transplant relapse was significantly lower in the middle (HR 0.62 [0.48\u20130.80]) and late periods (HR 0.68 [0.52\u20130.90]) than in the early period. Thus, recent advances appear to have contributed to increased opportunities for therapeutic interventions, leading to improved survival outcomes in patients with post\u2010transplant R\/R ATL.<\/jats:p>","DOI":"10.1111\/bjh.70631","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T05:56:12Z","timestamp":1781589372000},"page":"544-556","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improvements over time in survival after post\u2010transplant relapse of adult T\u2010cell leukaemia\/lymphoma and trends of salvage therapy in a real\u2010world experience"],"prefix":"10.1111","volume":"209","author":[{"given":"Hidehiro","family":"Itonaga","sequence":"first","affiliation":[{"name":"Transfusion and Cell Therapy Unit Nagasaki University Hospital  Nagasaki 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