Adult T-cell leukemia natural history, complications and prognosis: Difference between revisions
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{{Adult T-cell leukemia}} | |||
{{CMG}} {{AE}} {{HL}} | |||
==Overview== | |||
The [[Natural history of disease|natural history]] of adult T-cell leukemia varies between the different subtypes of the disease. Common complications of adult T-cell leukemia include [[cardiac arrhythmia]]s, [[opportunistic infection]]s , and [[bone fracture]]s. The [[prognosis]] varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor [[prognosis]], where as chronic and smouldering subtypes have a good [[prognosis]]. | |||
==Natural History== | |||
* The [[Natural history of disease|natural history]] of adult T-cell leukemia varies between the different subtypes of the disease.<ref name="pmid18042693">{{cite journal| author=Matutes E| title=Adult T-cell leukaemia/lymphoma. | journal=J Clin Pathol | year= 2007 | volume= 60 | issue= 12 | pages= 1373-7 | pmid=18042693 | doi=10.1136/jcp.2007.052456 | pmc=PMC2095573 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18042693 }} </ref> | |||
* Usually patients with '''acute''' adult T-cell leukemia have an aggressive clinical course with a median survival period of less than 12 months. If left untreated, most of the patients with acute adult T-cell leukemia will develop [[B symptoms|constitutional symptom]]s, [[lymphadenopathy]], and [[organomegaly]] within a few weeks of [[diagnosis]]. | |||
* Usually patients with '''chronic''' adult T-cell leukemia will have an stable clinical course. If left untreated, most of the patients with chronic adult T-cell leukemia will develop [[lymphocytosis]] for months, or even years, before presenting with the typical [[cutaneous]] manifestations. | |||
* Most patients with '''smoldering''' adult T cell leukemia are initially [[asymptomatic]]. If left untreated, most of the patients with smoldering adult T cell leukemia will develop [[steroid]]-responsive [[skin]] [[rash]] and multiple [[lung]] infiltrates. | |||
==Complications== | |||
* Common complications of adult T-cell leukemia include:<ref name="pmid18042693">{{cite journal| author=Matutes E| title=Adult T-cell leukaemia/lymphoma. | journal=J Clin Pathol | year= 2007 | volume= 60 | issue= 12 | pages= 1373-7 | pmid=18042693 | doi=10.1136/jcp.2007.052456 | pmc=PMC2095573 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18042693 }} </ref><ref name="wiki">Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref> | |||
:* [[Cardiac arrhythmia]]s (due to [[hypercalcaemia]]) | |||
:* [[Opportunistic infection]]s ([[Strongyloides stercoralis]] infection is a frequent cause of death among adult T-cell leukemia patients) | |||
:* [[Bone]] [[fracture]]s (due to [[lytic]] [[bone]] lesions) | |||
:* [[Anemia]] | |||
:* Recurrent [[bleeding]] | |||
==Prognosis== | |||
* The [[prognosis]] varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor [[prognosis]], where as chronic and smoldering subtypes have a good [[prognosis]].<ref name="pmid26361794">{{cite journal| author=Katsuya H, Ishitsuka K, Utsunomiya A, Hanada S, Eto T, Moriuchi Y et al.| title=Treatment and survival among 1594 patients with ATL. | journal=Blood | year= 2015 | volume= 126 | issue= 24 | pages= 2570-7 | pmid=26361794 | doi=10.1182/blood-2015-03-632489 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26361794 }} </ref> | |||
:* The 4-year overall survival rate of patients with acute adult T-cell leukemia is approximately 11%. | |||
:* The 4-year overall survival rate of patients with adult T-cell lumphoma is approximately 16%. | |||
:* The 4-year overall survival rate of patients with chronic adult T-cell leukemia is approximately 36%. | |||
:* The 4-year overall survival rate of patients with smouldering adult T-cell leukemia is approximately 52%. | |||
* The table below lists [[prognostic]] factors for adult T-cell leukemia patients:<ref name="pmid18042693">{{cite journal| author=Matutes E| title=Adult T-cell leukaemia/lymphoma. | journal=J Clin Pathol | year= 2007 | volume= 60 | issue= 12 | pages= 1373-7 | pmid=18042693 | doi=10.1136/jcp.2007.052456 | pmc=PMC2095573 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18042693 }} </ref><ref name="pmid26361794">{{cite journal| author=Katsuya H, Ishitsuka K, Utsunomiya A, Hanada S, Eto T, Moriuchi Y et al.| title=Treatment and survival among 1594 patients with ATL. | journal=Blood | year= 2015 | volume= 126 | issue= 24 | pages= 2570-7 | pmid=26361794 | doi=10.1182/blood-2015-03-632489 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26361794 }} </ref><ref name="pmid20425378">{{cite journal| author=Mahieux R, Gessain A| title=Adult T-cell leukemia/lymphoma and HTLV-1. | journal=Curr Hematol Malig Rep | year= 2007 | volume= 2 | issue= 4 | pages= 257-64 | pmid=20425378 | doi=10.1007/s11899-007-0035-x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20425378 }} </ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" | |||
| valign="top" | | |||
|+ | |||
! style="background: #4479BA; width: 250px; color: #FFFFFF;" |'''Prognostic Factor''' | |||
! style="background: #4479BA; width: 600px; color: #FFFFFF;" |'''Description''' | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Clinical subtype'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* Acute and lymphomatous subtypes have a poor prognosis, where as chronic and smouldering subtypes have a good [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Gender'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* Males are associated with a worse [[prognosis]] when compared to females. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Performance status'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* Patient's poor [[performance status]] is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Calcium level'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* [[Hypercalcemia]] is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Leukocyte count'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* An elevated [[leukocyte]] count is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Lactate dehydrogenase (LDH) level'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* Elevated level of [[LDH]] is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''β2-microglobulin level '''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* An elevated [[globulin|β2-microglobulin]] level is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Lymphocyte surface markers'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* Over expression of [[CD25]] is associated with a worse [[prognosis]]. | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Neuron‐specific enolase'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
:* An elevated [[neuron]]‐specific [[enolase]] level is associated with a worse [[prognosis]]. | |||
|} | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Medicine]] | |||
[[Category:Hematology]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Primary care]] | |||
[[Category:Immunology]] |
Revision as of 00:57, 2 November 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
The natural history of adult T-cell leukemia varies between the different subtypes of the disease. Common complications of adult T-cell leukemia include cardiac arrhythmias, opportunistic infections , and bone fractures. The prognosis varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor prognosis, where as chronic and smouldering subtypes have a good prognosis.
Natural History
- The natural history of adult T-cell leukemia varies between the different subtypes of the disease.[1]
- Usually patients with acute adult T-cell leukemia have an aggressive clinical course with a median survival period of less than 12 months. If left untreated, most of the patients with acute adult T-cell leukemia will develop constitutional symptoms, lymphadenopathy, and organomegaly within a few weeks of diagnosis.
- Usually patients with chronic adult T-cell leukemia will have an stable clinical course. If left untreated, most of the patients with chronic adult T-cell leukemia will develop lymphocytosis for months, or even years, before presenting with the typical cutaneous manifestations.
- Most patients with smoldering adult T cell leukemia are initially asymptomatic. If left untreated, most of the patients with smoldering adult T cell leukemia will develop steroid-responsive skin rash and multiple lung infiltrates.
Complications
- Cardiac arrhythmias (due to hypercalcaemia)
- Opportunistic infections (Strongyloides stercoralis infection is a frequent cause of death among adult T-cell leukemia patients)
- Bone fractures (due to lytic bone lesions)
- Anemia
- Recurrent bleeding
Prognosis
- The prognosis varies between the subtypes of adult T-cell leukemia; acute and lymphomatous subtypes have a poor prognosis, where as chronic and smoldering subtypes have a good prognosis.[3]
- The 4-year overall survival rate of patients with acute adult T-cell leukemia is approximately 11%.
- The 4-year overall survival rate of patients with adult T-cell lumphoma is approximately 16%.
- The 4-year overall survival rate of patients with chronic adult T-cell leukemia is approximately 36%.
- The 4-year overall survival rate of patients with smouldering adult T-cell leukemia is approximately 52%.
- The table below lists prognostic factors for adult T-cell leukemia patients:[1][3][4]
Prognostic Factor | Description |
---|---|
Clinical subtype |
|
Gender |
|
Performance status |
|
Calcium level |
|
Leukocyte count | |
Lactate dehydrogenase (LDH) level | |
β2-microglobulin level |
|
Lymphocyte surface markers | |
Neuron‐specific enolase |
References
- ↑ 1.0 1.1 1.2 Matutes E (2007). "Adult T-cell leukaemia/lymphoma". J Clin Pathol. 60 (12): 1373–7. doi:10.1136/jcp.2007.052456. PMC 2095573. PMID 18042693.
- ↑ Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015
- ↑ 3.0 3.1 Katsuya H, Ishitsuka K, Utsunomiya A, Hanada S, Eto T, Moriuchi Y; et al. (2015). "Treatment and survival among 1594 patients with ATL". Blood. 126 (24): 2570–7. doi:10.1182/blood-2015-03-632489. PMID 26361794.
- ↑ Mahieux R, Gessain A (2007). "Adult T-cell leukemia/lymphoma and HTLV-1". Curr Hematol Malig Rep. 2 (4): 257–64. doi:10.1007/s11899-007-0035-x. PMID 20425378.