[Clinical analysis of 12 cases of Chinese patients with adult T-cell leukemia/lymphoma].

OBJECTIVE

To define the clinical characteristics and differential diagnosis in Chinese patients with adult T-cell leukemia/lymphoma (ATLL) and its relation to human T lymphotropic virus type-1 (HTLV-1) infection.

METHODS

Lymphocyte morphology in peripheral blood was examined in smears by Cytospin II. Lymphocyte immunophenotyping was carried out by indirect immunofluorescence method. HTLV-1 antibody was detected by indirect immunofluorescence method, proviral DNA detected by PCR method and PCR products demonstrated by Southern Blot analysis.

RESULTS

The clinical manifestations in these 12 patients were fever (10/12), lymphadenopathy (8/12), skin changes (7/12), spleen and liver enlargement (7/12), jaundice (3/12), pleural effusion (1/12) and lung invasion (1/12). Patul-like cells were not easily found in routine blood smears, but easily found with Cytospin II (10/10). There was increase in lactic dehydrogenase (8/9) and soluble interleukin 2 receptor (9/9). Anemia (7/12), thrombocytopenia (6/12), pancytopenia (2/12), myelodysplasia (4/12) and eosinophilia (8/12) can be found, but no hypercalcemia. HTLV-1 antibody and proviral DNA were positive in 6/10 cases and 9/12 cases respectively. Nine cases were classified as acute type and three as lymphoma type. All patients were misdiagnosed as other diseases at the beginning. The initial presentations were skin changes (4/12), lymphadenopathy (3/12), myelodysplasia (3/12), progressive liver enlargement (1/12) and refractory pleural effusion (1/12). The complications were infections by undetermined pathogens (6/12), Streptococcal infection (1/12), gastrointestinal bleeding (3/12), acute renal failure (3/12), acute respiratory failure (2/12) and cerebral hemorrhage (1/12). Seven patients died, three still survive, and two are out of contact.

CONCLUSION

ATLL may not be very rare in China. It is necessary to deepen the recognition of ATLL in Chinese.