Background: ATLL is an aggressive T cell lymphoma (TCL) associated with HTLV1 infections, endemic to certain regions. The acute and lymphomatous types have the poorest prognoses of any TCL, and their responses to standard therapy with CHOP, are brief. Methods: Charts of patients at Kings County Hospital in Brooklyn, NY from 2002-14 with acute and lymphomatous ATLL were retrospectively reviewed. They were treated with EPOCH, and had serology positive for HTLV1 Results: Records of 43 patients were reviewed, 34females and 23males. Median age at diagnosis was 54 years (range 31-78). Stage at diagnosis was 26%, 51%, 16%, 6% in stage I, II, III, IV respectively. Median follow up period is 6.6 months (m). At the end of follow up 34 patients were dead, 5 alive and rest lost to follow up. EPOCH was associated with overall survival of 6.7m and progression free survival of 4.8m. Complete responses were seen in 26% of EPOCH treated patients. In patients who underwent second or third line chemotherapy, median PFS after 1^st and 2^nd relapse were 6.8 weeks and 61 days. No patient underwent stem cell transplant (SCT). CNS involvement at presentation was 5%. CNS relapse rate in patients who got intrathecal (IT) methotrexate (MTX) versus who didn’t was 14% and 21%. All patients with CNS relapse were also found to have a concurrent peripheral relapse. Pts with Calcium over 11 had worse survival than those below 11, of 3.5 m vs 8 m. Patients with LDH twice the normal limit had worse survival that those without that, 4.7 m vs. 12 m. Patients with bone marrow involvement by ATLL had worse survival that those without, 3.8 m vs 11.7 m. Conclusions: EPOCH induces remissions in a significant minority of ATLL patients, of short duration, and hardly change prognosis. Such remissions might be a good time to initiate allogeneic SCT, but the value of this treatment is not yet established. IT MTX shows no impact on recurrence.