Nodal T-cell lymphoma in an HTLV-I-endemic area: proviral HTLV-I DNA, histological classification and clinical evaluation
Nodal T-cell lymphoma in an HTLV-I-endemic area: proviral HTLV-I DNA, histological classification and clinical evaluation
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DOI：
10.1046/j.1365-2141.1998.00761.x
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发表时间：
1998-06-01
影响因子：
6.5
通讯作者：
Kikuchi, M
中科院分区：
文献类型：
--
作者：
Ohshima, K;Suzumiya, J;Kikuchi, M
成人t细胞白血病/淋巴瘤（ATLL）是一种与人类t细胞白血病病毒I型（HTLV-I）相关的人类恶性肿瘤。组织学通常显示多形性，但不一致。为了明确ATLL的组织学分型与预后的关系，并证实HTLV-I克隆整合的意义，我们对572例淋巴结t细胞淋巴瘤进行了重新分类，其中t细胞表型和/或基因型得到确认。在所有病例中，HTLV-I前病毒DNA在淋巴结中的克隆整合均通过Southern blot分析进行检测。此外，对血清中抗atl抗原（ATLA）进行检测或对淋巴结中HTLV-I pX扩增进行PCR分析，313例ATLA患者中有66例（21%）未发现HTLV-T克隆整合的证据。572例患者分为3组：(A)克隆整合247例，(B)未克隆整合HTLV-I前病毒DNA的ATLA组（66例），(C)未克隆整合ATLA组（259例）。组织学上，B组和C组经常表现为大细胞型和血管免疫母细胞性淋巴结病伴蛋白异常血症（AILD）型；而A组则倾向于多形型。临床上，A组患者预后差于B组和c组。综上所述，A组患者被定义为ATLL （HTLV-I相关t细胞淋巴瘤），而B组患者被归类为t细胞淋巴瘤，这恰好发生在HTLV-I感染的携带者中。REAL的简化分类提示临床结局：ATLL预后较差，未明确类型为中等，而其他类型淋巴母细胞型、AILD和间变性大细胞型均较好。
Adult T-cell leukaemia/lymphoma (ATLL) is a human malignancy associated with human T-cell leukaemia virus type I (HTLV-I). The histology usually indicates a pleomorphic type, but is not consistent. To clarify the relationship between the histological classification and prognosis in ATLL, and to confirm the significance of clonal HTLV-I integration, we reclassified 572 cases with nodal T-cell lymphoma in which the T-cell phenotype and/or genotype was confirmed. In all cases the clonal integration of HTLV-I proviral DNA in the lymph nodes was examined by Southern blot analysis. In addition, anti-ATL antigen (ATLA) determination in the serum or PCR analysis of HTLV-I pX amplification in lymph nodes was also performed, 66/313 (21%) cases with ATLA had no evidence of clonal HTLV-T integration. 572 cases were classified into three groups: (A) cases with clonal integration (247 cases), (B) cases with ATLA without clonal integration of HTLV-I proviral DNA (66 cases), (C) cases without ATLA (259 cases). Histologically, groups B and C frequently demonstrated large cell type and angioimmunoblastic lymphadenopathy with dysproteinaemia (AILD) type; however, group A tended to show a pleomorphic type. Clinically, group A showed a poorer prognosis than groups B and C.In conclusion, group A cases were defined as ATLL (HTLV-I-associated T-cell lymphoma), whereas group B was classified as T-cell lymphoma, which had coincidently occurred in HTLV-I infected carriers. The simplified classification of REAL indicated clinical outcome: the prognosis of ATLL was poor, the unspecified type was intermediate, whereas the other types of lymphoblastic, AILD and anaplastic large cell type were all relatively favourable.