Gibbs W N, Lofters W S, Campbell M, Hanchard B, LaGrenade L, Clark J, Cranston B, Saxinger C, Gallo R, Blattner W A
Princess Takamatsu Symp. 1984;15:77-90.
We had shown previously that the prevalence of human T-cell leukemia/lymphoma virus type I (HTLV-I)-antibody positivity is high in Jamaican non-Hodgkin's lymphoma (NHL) patients and that virus-positive patients have the clinical features and poor prognosis of adult T-cell leukemia/lymphoma (ATL). Sixty-two % of 45 NHL patients diagnosed consecutively between 2/1/82 and 1/31/84 and studied prospectively were HTLV-I-antibody positive. Skin involvement (38%), hypercalcemia (44%), and leukemia (40%) were unusually prevalent and there was a strong association (p less than 0.05) with HTLV-I-antibody positivity. Fifty-two % of the patients had bone marrow infiltration, and 74% of these patients were HTLV-I-antibody positive (p = 0.06). Lymphadenopathy (96%), hepatomegaly (60%), and splenomegaly (25%) were detected with about the same frequency as in other series of NHL patients with advanced disease, and 61-88% of these patients were HTLV-I-antibody positive. Patients were classified into those with "typical ATL" (NHL associated with 2 of the 4 features i) hypercalcemia; ii) histologically proven skin infiltration; iii) leukemia; and iv) bone marrow infiltration, providing that the morphology of infiltrating or leukemic cells was characteristic of ATL; those "consistent with ATL" (NHL associated with 1 of these 4 features); and "non-ATL" (NHL without any of these 4 additional features). Thirty-two (71%) of the NHL patients were ATL patients, i.e., had features typical of or consistent with ATL, and 78% of these were HTLV-I-antibody positive. HTLV-I provirus was detected in tumour cells of all HTLV-I-antibody positive patients tested. Three (23%) of the non-ATL patients were HTLV-I-antibody positive. There was no correlation between histopathological features and the clinical classification or HTLV-I-antibody positivity. Median survival of ATL and non-ATL patients was 16 and 53 weeks. Although the disease was usually fulminant, 34% of the ATL patients had a subacute or chronic course. Skin involvement and leukemia were prominent in these patients. Hypercalcemia was the chief prognostic determinant. Median survival of hypercalcemic and normocalcemic ATL patients was 13 and 86 weeks (p less than 0.05). Hypercalcemia caused 10 deaths, infections 12, and death was due to tumour progression in 4 patients. Infections were usually due to pyogenic organisms and only 2 patients had systemic opportunistic infections. Six (27%) of 22 chronic lymphocytic leukemic (CLL) patients were HTLV-I-antibody positive.(ABSTRACT TRUNCATED AT 400 WORDS)
我们之前已经表明，在牙买加非霍奇金淋巴瘤（NHL）患者中，人类T细胞白血病/淋巴瘤病毒I型（HTLV-I）抗体阳性率很高，并且病毒阳性患者具有成人T细胞白血病/淋巴瘤（ATL）的临床特征和不良预后。在1982年2月1日至1984年1月31日期间连续诊断并进行前瞻性研究的45例NHL患者中，62%为HTLV-I抗体阳性。皮肤受累（38%）、高钙血症（44%）和白血病（40%）异常普遍，并且与HTLV-I抗体阳性有很强的关联（p<0.05）。52%的患者有骨髓浸润，其中74%的患者HTLV-I抗体阳性（p=0.06）。淋巴结病（96%）、肝肿大（60%）和脾肿大（25%）的检出频率与其他晚期NHL患者系列大致相同，这些患者中有61%-88%为HTLV-I抗体阳性。患者被分为“典型ATL”（NHL伴有以下4个特征中的2个：i）高钙血症；ii）组织学证实的皮肤浸润；iii）白血病；iv）骨髓浸润，前提是浸润或白血病细胞的形态具有ATL特征）；“符合ATL”（NHL伴有这4个特征中的1个）；以及“非ATL”（NHL不具备这4个额外特征中的任何一个）。32例（71%）NHL患者为ATL患者，即具有典型或符合ATL的特征，其中78%为HTLV-I抗体阳性。在所有检测的HTLV-I抗体阳性患者的肿瘤细胞中均检测到HTLV-I前病毒。3例（23%）非ATL患者为HTLV-I抗体阳性。组织病理学特征与临床分类或HTLV-I抗体阳性之间无相关性。ATL和非ATL患者的中位生存期分别为16周和53周。尽管该疾病通常进展迅速，但34%的ATL患者病程为亚急性或慢性。这些患者中皮肤受累和白血病较为突出。高钙血症是主要的预后决定因素。高钙血症和血钙正常的ATL患者的中位生存期分别为13周和86周（p<0.05）。高钙血症导致10例死亡，感染导致12例死亡，4例患者死于肿瘤进展。感染通常由化脓性 organisms引起，只有2例患者有全身性机会性感染。22例慢性淋巴细胞白血病（CLL）患者中有6例（27%）为HTLV-I抗体阳性。（摘要截短至400字）
