Comparative study of ATL and HTLV-I related disorders

人类嗜T淋巴细胞病毒I型（HTLV-I）在病因学上与称为成人T细胞白血病（ATL）的血液恶性肿瘤和称为HTLV-I相关性脊髓病/热带痉挛性下肢轻瘫（HAM/TSP）的慢性神经系统疾病相关。HTLV-I感染在世界某些地区是地方性的，例如，日本南部、加勒比海盆地。在美国、英国、法国和荷兰研究的ATL患者中，许多人来自加勒比地区。仅在日本，每年就有120万人检测到抗HTLV-I抗体，并诊断出700多例ATL病例。然而，在中美洲和南美洲的一些地区，观察到许多HAM/TSP患者，但没有那么多ATL患者。在日本、加勒比海和非洲患者中，ATL的临床病程、ATL亚型、高钙血症和机会性感染的频率、细胞形态、表型特征和治疗反应似乎相同。其中一个差异是发病年龄：加勒比和非洲患者的平均年龄低于日本ATL患者。与日本病例相比，加勒比国家的慢性亚型相对较少，而淋巴瘤型在牙买加比日本更常见，记录的差异原因尚不清楚。环境和遗传的影响可能是显着的，在提供不同的辅因子影响的疾病的表现。

Human T lymphotropic virus type I (HTLV-I) has been etiologically associated with a hematological malignancy termed adult T-cell leukemia (ATL) and a chronic neurological disease named HTLV-I associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-I infection is endemic in some areas of the world, for example, the southern part of Japan, the Caribbean basin. Many of the ATL patients studied in the USA, the UK, France, and the Netherlands originated from the Caribbean area.Antibodies against HTLV-I have been detected in 1.2 million people and more than 700 cases of ATL are diagnosed each year in Japan alone. However, in some areas of Central and South America many HAM/TSP patients are observed but not so many ATL patients. Clinical course, ATL subtype, frequencies of hypercalcemia and opportunistic infections, cell morphology, phenotypic profile, and response to treatment seem to be the same for ATL in Japanese, Caribbean, and African patients. One of the differences is in age at onset : the average age is lower for the Caribbean and African than for Japanese ATL patients. And there is a relative paucity of the chronic subtype in Caribbean countries as compared to Japanese cases, while the lymphoma type is more common in Jamaica than in Japan.The reasons for the differences recorded are not clear. Environmental and genetic influences may be significant in providing different cofactors affecting the manifestations of the disease.