Survival of patients with HTLV-I-associated lymph node lesions

Abstract

Adult T‐cell leukaemia/lymphoma (ATLL), is a malignant condition associated with human T‐cell leukaemia virus type I (HTLV‐I). Usually, although not uniformly, histopathological examination of the lymph nodes shows a pleomorphic type. In addition, some patients with pre‐overt ATLL show a Hodgkin's disease‐like morphology and lymph nodes in non‐neoplastic carriers show features of lymphadenitis. To characterize further the clinicopathological features of HTLV‐I‐associated lymphadenopathy, the histopathological features of the lymph nodes of 289 patients were classified into five types: lymphadenitis ( n=14), Hodgkin's‐like (Hodgkin's) ( n=18), pleomorphic (medium and large cells) ( n=219), pleomorphic small cell ( n=11), and anaplastic large cell (ALC) ( n=27). Survival data were analysed according to the histopathological features of the lymph nodes. The pleomorphic type, which showed typical features of ATLL, was associated with a highly aggressive course and an initially high mortality, followed by a rapid decrease in survival. This pattern was also observed in patients with the ALC type. All cases with lymphadenitis were still alive at the end of the study, while survival progressively decreased in the Hodgkin's type. The small cell type showed an initial rapid decrease in survival followed by a plateau. These results show that the survival trends of patients with pleomorphic and anaplastic lymph node lesions are similar to those with ATL lymphoma, while patients with the lymphadenitis type of lesion were considered to have a non‐neoplatic status. There is at present no effective therapy for ATLL, but in the future, these classification and survival data might be useful for the selection of appropriate chemotherapeutic regimens for patients with ATLL. Copyright © 1999 John Wiley & Sons, Ltd.

Adult T-cell leukemia/lymphoma with Epstein-Barr virus–positive Hodgkin-like cells

“…In terms of prognosis, patients with Hodgkin-like ATLL were noted to have an improved survival compared to other ATLL variants, including the small cell and pleomorphic variants [14]. Our patient has responded favorably to dose adjusted EPOCH-R, although he continued to have persistence of HTLV-1 in the peripheral blood by PCR and flow cytometry.…”

Repression of IRF-4 target genes in human T cell leukemia virus-1 infection

“…The abrogation of the mitotic checkpoint by IRF-4 and by Tax (Jin et al, 1998;Kasai et al, 2001) has important consequences for treatment options for ATL patients. Current ATL treatments are largely ineffective and provide at most a 5% 4-year survival rate (Cann and Chen, 1996;Ohshima et al, 1999). Recently, Kasai et al (2001) reported that ATL cells are chemoresistant to microtubule inhibitors such as nocodazole.…”

“…At present, it is estimated that between 10 and 20 million people worldwide are infected with HTLV. Treatments for ATL are ineffective; conventional chemotherapeutic treatments provide at most a 5% 4-year survival rate (Cann and Chen, 1996;Ohshima et al, 1999). Once diagnosed with acute ATL, the median survival time is in the order of a few months (Edlich et al, 2000;Tsukasaki et al, 2000).…”

Repression of DNA Repair Mechanisms in IRF-4-Expressing and HTLV-I-Infected T Lymphocytes

“…Treatments for ATL are ineffective; conventional chemotherapies provide at most a 4-year survival rate of 5%. (3) The median survival after diagnosis of acute ATL rarely exceeds a few months. (2) HTLV-I infection of CD4 ϩ T cells initiates a multistep oncogenic process characterized by an early proliferation of HTLV-I-infected T cells, resulting in a polyclonal expansion of infected cells.…”