Hattori Toshio

Kawano Fumio

Nishimura Hiromichi

Sanada Isao

Takatsuki Kiyoshi

Tsuda Hiroyuki

Yamaguchi Kazunari

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Trop. Med., 28 (Suppl.), 117-118, December, 1986117Clinical Aspects of Adult T-Cell Leukemia-Lymphoma (ATL)Kiyoshi TAKATSUKI, Kazunari YAMAGUCHI, Fumio KAWANO,Toshio HATTORI,Hiromichi NISHIMURA, Hiroyuki TSUDA, and Isao SANADAThe Second Department of Internal Medicine, KumamotoUniversityMedical School, Kumamoto 860, JapanATL is a unique T-cell malignancy first described byTakatsuki and colleagues in Kyoto in 1970s. We estimate that morethan 200 patients a year have been detected in Kyushu. Thesurface phenotype of ATL cells characterized by monoclonalantibodies is T3+, T4*, T8~, Tll+, and Tac. In all cases theserum is positive for antihuman T-cell leukemia (lymphotropic)virus (HTLV-I) antibodies and the ATL cells contain the proviralDNA of HTLV-I.Seventy-two patients with ATL have been examined in ourdepartment. Variations in the clinical features of atypical ATLsuggested a division of the spectrum of ATL into five types:acute (39 patients); chronic (12 patients); smoldering (8patients); crisis (5 patients); and lymphoma (8 patients). In allcases the serum was positive for anti-HTLV-I antibodies and themonoclonal integration of proviral DNA of HTLV-I in the malignantcells was confirmed. The acute type is the so-called prototypicATL, which progresses acutely or subacutely. In general a poorprognosis is indicated by the elevation of serum lactatedehydrogenase, calcium, and bilirubin, as well as by high WBC.Smoldering ATL is characterized by the presence of a few abnormal118cells (0.5-3%) in the peripheral blood over a long period. Crisisin chronic or smoldering ATL means the progression of the diseaseto acute ATL. The lymphoma type of ATL is considered to be a formof T-cell-type non-Hodgkin1s lymphoma in which malignant cellscontain proviral DNA of HTLV-I. In addition our experiences witha concurrence of lymphoma-type ATL in three sisters andspontaneous remissions in a patient with chronic ATL will bediscussed.Screening of the sera from healthy adults for presence of theanti-HTLV-I antibodies revealed that 3.6% of healthy individualsin Kumamoto Prefecture, which is located in the middle of Kyushu,were HTLV-I carriers. The percentage of positivity increased withage and was higher in females than in males. It varied from townto town, ranging from 0 to 17.6%. Family studies showed that theroutes of natural infection of HTLV-I are from mother to child andalso from husband to wife. The third route is blood transfusion.The borderline between the healthy carrier state and smolderingATL remains unclear. In the endemic areas smoldering ATL isfrequently diagnosed in patients with fungus infection of theskin, chronic lymphadenopathy, interstitial pneumonitis, chronicrenal failure and stronglyloidiasis.The sera from 48 patients with ATL and 23 healthy carriersinfected with HTLV-I were examined for the presence of antibodiesto HTLV-III by a strip radioimmunoassay based on the western blottechnique. None reacted to HTLV-III related proteins (p!5, p24,gp41) , suggesting that coincidental infection of HTLV-I andHTLV-III is quite rare in Japan.

Clinical Aspects of Adult T-Cell Leukemia-Lymphoma (ATL)

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Clinical Aspects of Adult T-Cell Leukemia-Lymphoma (ATL)

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