Clinical characteristics of lymphomatous form of Adult T cell lymphoma-leukemia in Peru

Pimentel, Paola; Beltrán, Brady E; Flores, Daniel el Silva-Herzog; Ferrel, Gabriela L.; Falcon, S.; Vera, Luis; Figueroa, Angélica; Portugal, K.; Bermúdez, Valmore

doi:10.1200/jco.2005.23.16_suppl.6728

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“…HTLV-1 infection is strongly associated to the development of ATLL and several Peruvian studies on clinical characteristics and outcomes of patients with ATLL have been reported [ 20 ]. Although HTLV-1 has not been associated with the development of B-cell lymphomas, HTLV-1 carriers with B-cell lymphoma tend to have a worse prognosis [ 21 ]. Theoretically, chronic HTLV-1 infection can cause T-cell dysfunction and B-cell proliferation inducing a particular state of immunosuppression favoring lymphomagenesis.…”

Section: Resultsmentioning

confidence: 99%

EBV-positive diffuse large B-cell lymphoma in a human T-lymphotropic virus type 1 carrier

Beltrán

Salas

Quiñones

et al. 2009

Infect Agents Cancer

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The development of B-cell lymphomas has been seldom described in HTLV-1 carriers. We present the case of an elderly Peruvian HTLV-1 carrier who was diagnosed with EBV-positive diffuse large B-cell lymphoma. Despite an initial good response to therapy, patient died during treatment due to fatal Pneumocystis jirovecci pneumonia. EBV infection is characterized by B-cell lymphotropism and selective immunodeficiency. HTLV-1, on the other hand, induces T-cell dysfunction and B-cell proliferation. Finally, immunosenescence is characterized by T-cell dysregulation, decreased apoptosis and cytokine upregulation. In this elderly patient, the combination of EBV and HTLV-1 coinfection and immunosenescence may have played a role in the development of this aggressive diffuse large B-cell lymphoma. Furthermore, the immunodeficiency caused by the viral infections and chemotherapy may have played a role in developing life-threatening infectious complications. FindingsThe Epstein Barr virus (EBV) was the first described oncovirus, which has been associated with the development of a variety of lymphoproliferative disorders, such as Burkitt . EBV infection occurs early in childhood, and approximately 90 to 95% of adults worldwide are EBV-seropositive. EBV expression has also been reported in patients with diffuse large B-cell lymphoma (DLBCL) [6]. DLBCL is the most common variant of nonHodgkin lymphoma in the United States (US) and accounts for approximately 25-30% of the cases [7]. In Peru, DLBCL accounts for up to 45% of all lymphomas and, akin to Asian countries, there is high incidence of Tcell lymphomas and low incidence of follicular lymphomas [8]. On the other hand, the human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus and is the pathogenic agent of adult T-cell lymphoma/leukemia (ATLL) and other diseases [9]. HTLV-1 is endemic in Japan, the Melanesian Islands, the Caribbean, South America, the Middle East and parts of Africa. The prevalence of HTLV-1 in Europe and the US is lower than 1%. In Peru, it is estimated that up to 3% of the healthy adult population carry HTLV-1 [10]. The interaction of these two oncoviruses, EBV and HTLV-1, has seldom been reported in the medical literature.

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Section: Resultsmentioning

confidence: 99%