T-cell leukemia natural history, complications and prognosis: Difference between revisions

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Latest revision as of 23:36, 12 November 2018

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

Common complications of adult T-cell leukemia include:^[1]^[2]

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] ^[5]


Prognostic Factor	Description

Clinical subtype	Acute and lymphomatous subtypes have a poor prognosis, where as chronic and smouldering subtypes have a good prognosis.
Gender	Males are associated with a worse prognosis when compared to females.
Performance status	Patient's poor performance status is associated with a worse prognosis.
Proliferative index higher than 18%	is associated with a worse prognosis.
Calcium level	Hypercalcemia is associated with a worse prognosis.
Lactate dehydrogenase (LDH) level	Elevated level of LDH is associated with a worse prognosis.
β2-microglobulin level	An elevated β2-microglobulin level is associated with a worse prognosis.
Lymphocyte surface markers	Over expression of CD25 is associated with a worse prognosis.
Neuron‐specific enolase	An elevated neuron‐specific enolase level is associated with a worse prognosis.

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.CS1 maint: PMC format (link)
↑ 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.
↑ Rodríguez-Zúñiga M, Cortez-Franco F, Qujiano-Gomero E (June 2018). "Adult T-Cell Leukemia/Lymphoma. Review of the Literature". Actas Dermosifiliogr. 109 (5): 399–407. doi:10.1016/j.ad.2017.08.014. PMID 29685460. Vancouver style error: initials (help)

Template:WH Template:WS

[pmid18042693-1] 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.CS1 maint: PMC format (link)

[wiki-2] Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015

[pmid26361794-3] 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.

[pmid20425378-4] 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.

[pmid29685460-5] Rodríguez-Zúñiga M, Cortez-Franco F, Qujiano-Gomero E (June 2018). "Adult T-Cell Leukemia/Lymphoma. Review of the Literature". Actas Dermosifiliogr. 109 (5): 399–407. doi:10.1016/j.ad.2017.08.014. PMID 29685460. Vancouver style error: initials (help)

[1]

[2]

[3]

[4]

[5]

@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}} {{HL}}
 ==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 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.<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><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>
+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 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>
+* 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 '''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.
+* 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=wiki>Adult T-cell leukemia/lymphoma. Wikipedia (2015) https://en.wikipedia.org/wiki/Adult_T-cell_leukemia/lymphoma Accessed on November, 3 2015</ref><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>
+* 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 is a frequent cause of death)
+:* [[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]]
@@ Line 19: / Line 19: @@
 ==Prognosis==
-* 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.<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 [[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>
+* 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> <ref name="pmid29685460">{{cite journal |vauthors=Rodríguez-Zúñiga MJM, Cortez-Franco F, Qujiano-Gomero E |title=Adult T-Cell Leukemia/Lymphoma. Review of the Literature |journal=Actas Dermosifiliogr |volume=109 |issue=5 |pages=399–407 |date=June 2018 |pmid=29685460 |doi=10.1016/j.ad.2017.08.014 |url=}}</ref>
 {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
-|valign=top|
+| valign="top" |
 |+
-! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Prognostic Factor'''
+! style="background: #4479BA; width: 250px; color: #FFFFFF;" |'''Prognostic Factor'''
-! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description'''
+! 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;" |
+| 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.
+:* 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 | '''Age'''|| style="padding: 5px 5px; background: #F5F5F5;"|
+| 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.
+:* 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;" |
-| 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]].
-:* 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;" |
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Proliferative index higher than 18%'''|| style="padding: 5px 5px; background: #F5F5F5;" |
-:* [[Hypercalcemia]] is associated with a worse prognosis.
+:*  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;" |
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Leukocyte count'''|| style="padding: 5px 5px; background: #F5F5F5;" |
+:* [[Hypercalcemia]] is associated with a worse [[prognosis]].
-:* 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;"|
+| 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.
+:* 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;"|
+| 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.
+:* 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;"|
+| 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.
+:* 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;"|
+| 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.
+:* An elevated [[neuron]]‐specific [[enolase]] level is associated with a worse [[prognosis]].
 |}
@@ Line 84: / Line 82: @@
 [[Category:Pathology]]
 [[Category:Hematology]]
+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Hematology]]
+[[Category:Immunology]]