Adult T-cell leukemia-lymphoma in the Hokuriku District and presentation of a case in hematological remission after cryptococcus infection.

Ten cases of adult T-cell leukemia-lymphoma (ATL/L) in the Hokuriku district were studied. Five patients were born in endemic areas and later moved to Hokuriku. Five patients were from nonendemic areas, and have not lived in endemic areas. All of the five patients from nonendemic areas had antibody to the adult T-cell leukemia cell-associated antigen (anti-ATLA), and they had anti-ATLA-positive members in their families. Four of the six patients examined had ATL virus (ATLV) proviral DNA in their leukemic cells and type C virus particles were found in the cultured cell line from one of them (case S.D.). The incidence of anti-ATLA in the control population was 0.93% in Ishikawa Prefecture, 0.39% in Toyama Prefecture and 0% in Fukui Prefecture. The overall positive rate in the controls in Hokuriku was 0.49%. The rate of positive anti-ATLA among family members of seven ATL patients (patients are excluded) was 43.5% (17/39). The pedigree study of ATL patients very strongly suggested transmission of ATLV between spouses and transmission from mother to children. We also report a case of ATL from an endemic area, who has been in remission without antileukemic therapy for about one year. He is on 5 FC (5-fluorocytosine), Minomycin (minocycline hydrochloride), and Baktar (trimethoprim-sulfamethoxazole). Possibility that the therapeutic effect of 5 FC on ATL or the remission is due to enhanced cellular immunity after cryptococcus infection is discussed.