Kamihira S, Atogami S, Sohda H, Momita S, Yamada Y, Tomonaga M
Blood Transfusion Service, Nagasaki University Hospital, Japan.
Cancer. 1994 Jun 1;73(11):2753-8. doi: 10.1002/1097-0142(19940601)73:11<2753::aid-cncr2820731117>3.0.co;2-x.
The authors conducted a survey of a large cohort of patients with adult T-cell leukemia (ATL) and a group of human T-cell leukemia virus type 1 (HTLV-1) carriers to elucidate whether measurements of soluble interleukin-2 receptor (sIL-2R) levels are indicative of ATL tumor burden and correlate with clinical progression.
Using a sandwich enzyme immunoassay, the authors determined sIL-2R in the serum of 135 patients with ATL diagnosed and subclassified according to the Japan Lymphoma Study Group criteria and in the serum of healthy HTLV-1 seropositive persons. Also included were patients in the preleukemic state of ATL (pre-ATL), which is characterized by only slight blood changes but does not fit the diagnostic criteria of ATL. In the five subjects who finally advanced to overt ATL, the authors prospectively performed serial measurements of the receptor.
Serial measurements of sIL-2R levels taken until overt ATL developed showed that these levels in the initial samples were higher than those of control subjects, even when subjects were asymptomatic or in the pre-ATL state. The serial levels of the five subjects gradually increased despite being in a clinically stable condition, finally reaching markedly high levels at the time ATL became overt. The mean sIL-2R levels of the smoldering, chronic, acute, and lymphoma subtypes of ATL were 1680 U/ml, 6680 U/ml, 45,940 U/ml, and 34,620 U/ml, respectively (P < 0.01). The sIL-2R levels of each subtype at the time of diagnosis were more correlated with tumor burden, malignant behavior, and prognosis than lactate dehydrogenase (LDH) levels. In the low, moderate, and high sIL-2R subgroups, the median survival time and percent survival probability at 2 years was 30.2 months (46.0%), 16.5 months (25.0%), and 7.7 months (15.3%), respectively.
Serial measurements of sIL-2R levels are of clinical importance because changes of the levels correlate with disease progression, especially in early phase of ATL. The data suggest that sIL-2R may be more useful than LDH. In addition, emphasis may be placed on sIL-2R as an indicator of ATL progression status and prognosis for survival. The value of this marker in clinical practice should be confirmed prospectively.
作者对一大群成人T细胞白血病（ATL）患者和一组人类T细胞白血病病毒1型（HTLV-1）携带者进行了调查，以阐明可溶性白细胞介素-2受体（sIL-2R）水平的测量是否能指示ATL肿瘤负荷并与临床进展相关。
作者使用夹心酶免疫测定法，测定了135例根据日本淋巴瘤研究组标准诊断并分类的ATL患者血清中的sIL-2R，以及健康的HTLV-1血清阳性者血清中的sIL-2R。还纳入了处于ATL白血病前期（pre-ATL）的患者，其特征仅为轻微血液变化但不符合ATL诊断标准。对于最终发展为显性ATL的5名受试者，作者前瞻性地对该受体进行了系列测量。
对发展为显性ATL之前的sIL-2R水平进行系列测量显示，即使受试者无症状或处于pre-ATL状态，初始样本中的这些水平也高于对照受试者。尽管5名受试者临床状况稳定，但该受体的系列水平仍逐渐升高，最终在ATL变为显性时达到显著高水平。ATL的冒烟型、慢性型、急性型和淋巴瘤型的平均sIL-2R水平分别为1680 U/ml、6680 U/ml、45940 U/ml和34620 U/ml（P<0.01）。与乳酸脱氢酶（LDH）水平相比，各亚型在诊断时的sIL-2R水平与肿瘤负荷、恶性行为和预后的相关性更强。在低、中、高sIL-2R亚组中，中位生存时间及2年生存率分别为30.2个月（46.0%）、16.5个月（25.0%）和7.7个月（15.3%）。
对sIL-2R水平进行系列测量具有临床重要性，因为其水平变化与疾病进展相关，尤其是在ATL早期。数据表明sIL-2R可能比LDH更有用。此外，可将sIL-2R作为ATL进展状态和生存预后的指标予以重视。该标志物在临床实践中的价值应通过前瞻性研究加以证实。
