Masahito Iwahashi

The prevalence of human T-cell leukemia virus type I infection in patients with hematologic and nonhematologic diseases in an adult T-cell leukemia-endemic area of Japan

In order to clarify the prevalence of human T‐cell leukemia virus type I (HTLV‐I) infection in the Kagoshima district, Japan, a highly endemic area for HTLV‐I, antibodies for HTLV‐I (anti‐HTLV‐I) were examined in the sera of 6167 from healthy residents and patients with various hematologic and nonhematologic diseases. In healthy residents, including blood donors, the prevalence of anti‐HTLV‐I was 11.9% (562/4741 persons). The prevalence increased with age, and was significantly higher in females than in males (P < 0.01). The prevalence of anti‐HTLV‐I in blood donors was 8.5%. In hematologic diseases, the prevalence of anti‐HTLV‐I was 98.3% in ATL, 28.9% in lymphoproliferative disorders except ATL, and 10.6% in myeloproliferative disorders. In nonhematologic diseases, the prevalence of anti‐HTLV‐I was shown to be 29.5% in pulmonary tuberculosis, 25.8% in leprosy, 33.8% in chronic renal failure (CRF), 21.9% in autoimmune diseases, and 47.8% in strongyloidiasis. The various diseases except myeloproliferative disorders had significantly higher prevalence of anti‐HTLV‐I than healthy residents (P < 0.01 or 0.05). For autoimmune diseases, the prevalence of anti‐HTLV‐I in patients with blood transfusion (55.6%) was higher than in those without blood transfusion (8.7%), and healthy residents. In hemodialysis patients with CRF who had received blood transfusions the prevalence of anti‐HTLV‐I increased with the number of blood transfusions. Therefore, HTLV‐I transmission via blood transfusion would partially explain these high prevalence of anti‐HTLV‐I. However, the prevalence of anti‐HTLV‐I in hemodialysis patients with CRF was statistically higher than that in healthy residents, regardless of blood transfusion (P < 0.01). Furthermore, hemodialysis patients showed significantly higher prevalence of anti‐HTLV‐I than healthy residents, even at a younger age. Patients with pulmonary tuberculosis and leprosy showed the same results as hemodialysis patients. These results suggest the possibility that HTLV‐I infection has some relation not only to ATL but also to other diseases. Therefore, it seems very important to halt the spread of HTLV‐I transmission as soon as possible.

Combination chemotherapy (RCM protocol: response-oriented cyclic multidrug protocol) for the acute or lymphoma type adult T-cell leukemia.

43 patients with the acute or lymphoma type ATL were treated with the new combination chemotherapy (RCM protocol: response-oriented cyclic multidrug protocol) between January 1989 and December 1991. Complete response (CR) and partial response (PR) were achieved in 20.9% and 65.1% of all treated patients respectively. The median duration of survival was 6.0 months. The survival duration of patients with a high serum lactate dehydrogenase (LDH) value (> or = 1,000 unit) and/or a poor performance status (PS) (PS 3 or 4) were also improved but not in patients with a severe leukocytosis (> or = 35,000/microliters). Toxicity was mild (grade 1 or 2) except hematologic toxicity in 4 patients (9.3%) and alopecia in one patient (2.3%). In spite of many patients with a poor PS (PS 3 or 4), our chemotherapeutic results are equal or superior to other previous reports. It seems that response-oriented chemotherapy is suitable for the ATL patients with poor prognostic factors. These results indicate that the RCM protocol is very useful as the first choice chemotherapy for the acute or lymphoma type ATL.

Primary effusion lymphoma with B-cell phenotype.

We describe here a case of primary effusion lymphoma that occurred in a 78‐year‐old woman. She was successively treated with prednisolone but died 15 months after the diagnosis of primary effusion lymphoma. The immunohistochemistry revealed the neoplastic cells to be CD19+, CD20+, CD21+, Sm‐Ig+, and HLA‐DR+. This patient exhibited clonal IgH and clonal κ light chain gene rearrangement, indicating a B‐cell origin. The present case was distinguished from the majority cases of HHV‐8‐positive primary effusion lymphoma. Here we present clinical details of response to therapy in this case. Am. J. Hematol. 64:317–318, 2000.

Serum dehydroepiandrosterone and DHEA-sulfate in patients with adult T-cell leukemia and human T-lymphotropic virus type I carriers

The serum levels of dehydroeplandrosterone (DHEA) and DHEA‐sulfate (DHEA‐S) were determined by radioimmunoassay in 38 patients with adult T‐cell leukemia (ATL). Levels of serum DHEA and DHEA‐S were also measured in 60 human T‐lymphotropic virus type I (HTLV‐I) carriers, and did not differ from those in 60 healthy control subjects. Serum levels in patients with ATL were lower than those in the age‐ and sex‐matched healthy controls and in HTLV‐I carriers with statistical significance. Serum DHEA and DHEA‐S in male patients with acute and lymphoma‐type ATL were 1.06 ± 0.77 ng/ml and 245.8 ± 192.9 ng/ml, respectively. Levels in male patients with chronic and smoldering‐type ATL were 1.69 ± 0.68 ng/ml and 477.6 ± 251.5 ng/ml, respectively. Serum levels of DHEA and DHEA‐S in patients with acute and lymphoma‐type ATL were significantly lower than those in patients with chronic and smoldering‐type ATL (P < 0.05).

Adult T-cell leukaemia in patients with OKT4 epitope deficiency.

Catovsky. D.. Rosa, M.. Goolden. A.W.C.. White, J.M., Bourikas. G., Brownell. A.I.. Blattner. W.A.. Greaves, M.F.. Calton. D.A.G., McCluskey. D.R.. Lampert. 1.. Ireland, R.. Bridges, J.M. & Gallo. R.C. ( 1 982) Adult T-cell lymphoma-leukemia in blacks from the West Indies. I~ncct. i. 639-643. Doerken. H. & Kehpenning. W. (1982) Lung cancer in butchers. Lancet. i. 561. Donham, K.J., Berg, 1.W. & Sawin. R.J. (1980) Epidemiological relationship of bovine population and human leukemia in Iowa. American journal oj Epidemiology. 12. 80-9 1 . Donham. K.J. & Van der Maaten. M.J. (1977) Seroepidemiological studies on a possible relationship of human and bovine leukemia. )aural oJ the National Cancer Institute. 59, 8 5 1-8 5 3 . Fox, A.J.. Lynge. E. & Malker. H. (1982) Lung cancer in butchers. Lancet. i, 165-1 66. Jaffe. E.S.. Blattner. W.A.. Blayney. D.W.. Bunn. P.A.. Cossman. I.. Robert-GurofT, M. & Gallo, R.C. ( 1 984) The pathologic spectrum of adult T-cell leukemia/lymphoma in the United States. American journal of Surgical Pathology, 8, 263-275. Johnson, E.S. & Fischman. H.K. (1982) Cancer mortality among butchers and slaughterhouse workers. Lancet. i, 91 3-914. Robert-GurofT. M.. Nakao. Y.. Notake. K., Ito, Y., Sliski. A. & Gallo, R.C. (1982) Natural antibodies to human retrovirus HTLV in a cluster of Japanese patients with adult T-cell leukemia. Science. 215,975-978.