Hematology and Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
Oncology (Williston Park). 2009 Dec;23(14):1250-6.
When oncologists diagnose patients suspected of lymphoid malignancy, it is important to consider the possibility of adult T-cell leukemia/lymphoma (ATL) with a routine check for serum human T-cell lymphotropic virus type 1 (HTLV-1) antibody. The following points are essential for the diagnosis of ATL: (1) cytologically or histologically proven peripheral T-cell malignancy, and (2) positivity for anti-HTLV-1 antibody. When a patient is diagnosed with ATL, it is important to make an accurate diagnosis of clinical subtype in order to make appropriate treatment decisions. For patients with smoldering or chronic type ATL, close observation with careful monitoring for opportunistic infections is recommended. For patients with the acute or lymphoma type requiring therapy, enrollment in a clinical trial is recommended. When there is no active trial or the patient is ineligible for a trial, we recommend intensive chemotherapy used for aggressive non-Hodgkin lymphoma such as the LSG15 regimen (VCAP-AMP-VECP) based on a recent phase III study. Because most patients with ATL are not curable with current chemotherapy regimens, it is reasonable to consider the applicability of allogeneic stem cell transplantation inpatients who show responses to chemotherapy. For relapsed or refractory patients, enrollment in a new-agent trial should be considered in addition to stem cell transplantation.
当肿瘤学家诊断疑似淋巴恶性肿瘤的患者时，重要的是要通过常规检查血清人 T 细胞嗜淋巴细胞病毒 1 型（HTLV-1）抗体来考虑成人 T 细胞白血病/淋巴瘤（ATL）的可能性。ATL 的诊断要点如下：（1）细胞学或组织学证实的外周 T 细胞恶性肿瘤，和（2）抗 HTLV-1 抗体阳性。当患者被诊断为 ATL 时，为了做出适当的治疗决策，重要的是要对临床亚型做出准确的诊断。对于处于亚临床或慢性型 ATL 的患者，建议密切观察并谨慎监测机会性感染。对于需要治疗的急性或淋巴瘤型患者，建议参加临床试验。当没有活跃的试验或患者不符合试验条件时，我们建议根据最近的 III 期研究，使用强化化疗治疗侵袭性非霍奇金淋巴瘤，如 LSG15 方案（VCAP-AMP-VECP）。由于目前的化疗方案不能治愈大多数 ATL 患者，因此对于对化疗有反应的患者，考虑同种异体干细胞移植的适用性是合理的。对于复发或难治性患者，除了干细胞移植外，还应考虑参加新药物试验。
