IntroductionAdult T-cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disorder associated with the human T-cell lymphotropic virus type 1 (HTLV-1). 1 HTLV-1 infection is endemic mainly in Japan and in the Caribbean, affecting 20 to 30 million individuals worldwide. HTLV-1 was the first human retrovirus in which monoclonal provirus integration in the host cellular DNA was observed. ATL occurs in only 2% to 4% of people infected with HTLV-1. The tumor syndrome comprises a proliferation of tumor CD4 ϩ T cells in peripheral blood, lytic bone lesions, and multiple visceral lesions with skin and lung infiltration. 2 It exhibits diverse clinical features ranging from chronic to acute forms.Smoldering and chronic forms exhibit a relatively good prognosis with an indefinite or 36-month median survival time, respectively. In these forms it is not yet demonstrated that treatment may improve prognosis and reduce the risk of evolution toward an acute form. In contrast, acute leukemic and lymphomatous forms of ATL have a very bad prognosis with a median survival of only 6 and 10 months, respectively, and a projected 4-year survival of about 5%. This is principally due to a severe immunodeficiency associated in some cases with opportunistic infections 3 and to an intrinsic resistance to high doses of chemotherapy. Novel treatments, such as the association of interferon ␣ (IFN-␣) and zidovudine (AZT), produced a high response rate in ATL patients with minimal side effects and seemed to prolong survival. [4][5][6][7] Yet, only a small percentage of patients achieve long-lasting remissions.HTLV-1-infected T cells overexpress markers of T-cell activation such as interleukin 2 receptor ␣ (IL-2R␣) when compared with uninfected stimulated T cells from the same donors. 8,9 Immunotherapy, using unlabeled or radiolabeled humanized antibodies directed against IL-2R␣, 10,11 have exploited the difference in IL-2R␣ expression between normal and malignant cells. However, clinical trials have shown that T cells derived from patients with acute ATL were in most cases resistant to anti-IL-2R␣ treatment. 10,12 The transferrin receptor (TfR) is another inducible receptor that is overexpressed in ATL cells, 13 whereas its background level in resting cells is very low. TfR is a disulfide-linked homodimeric transmembrane glycoprotein consisting of two 760-amino acid monomers of approximately 90 kDa each. TfR plays a crucial role in the regulation of iron uptake and cell growth. 14,15 When diferric transferrin binds to its cell surface receptor, it is internalized via clathrin-coated pits to acidic vesicles where the iron-transferrin complex is dissociated. 16,17 After release, the receptor and apotransferrin recycle back to the cell surface.TfR is constitutively expressed in cells of tissues that are constantly renewed, such as precursors of blood cells in the bone marrow, hepatocytes in the liver, keratinocytes in the epidermis, [17][18][19][20] More importantly, several studies have shown that TfR is expressed more abundantly in m...