T-cell leukemia natural history, complications and prognosis: Difference between revisions
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{{CMG}} {{AE}} {{HL}} | {{CMG}} {{AE}} {{HL}} | ||
==Overview== | ==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 | 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> | ||
==Natural History== | ==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 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 | * 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 skin manifestations. | * 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 [[skin]] manifestations. | ||
* Most patients with '''smouldering''' adult T cell leukemia are initially asymptomatic. If left untreated, most of the patients with smouldering adult T cell leukemia will develop steroid-responsive skin rash and multiple lung infiltrates. | * Most patients with '''smouldering''' adult T cell leukemia are initially asymptomatic. If left untreated, most of the patients with smouldering adult T cell leukemia will develop [[steroid]]-responsive [[skin]] [[rash]] and multiple [[lung]] infiltrates. | ||
==Complications== | ==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> | * 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> | ||
:* Cardiac | :* [[Cardiac arrhythmia]]s (due to [[hypercalcaemia]]) | ||
:* Opportunistic | :* [[Opportunistic infection]]s (due to defective a [[immune system]]) | ||
:* Bone | :* [[Bone]] [[fracture]]s (due to [[lytic]] [[bone]] lesions) | ||
==Prognosis== | ==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 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> | ||
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| 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 | '''Calcium level'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:* Hypercalcemia is associated with a worse prognosis. | :* [[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;" | | | 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. | :* An elevated [[leukocyte]] count is associated with a worse prognosis. | ||
|- | |- | ||
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| 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 β2-microglobulin level is associated with a worse prognosis. | :* An elevated [[globulin|β2-microglobulin]] level is associated with a worse prognosis. | ||
|- | |- | ||
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| 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 | :* An elevated [[neuron]]‐specific [[enolase]] level is associated with a worse prognosis. | ||
|} | |} | ||
Revision as of 20:40, 24 January 2016
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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.[1][2][3][4]
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 skin manifestations.
- Most patients with smouldering adult T cell leukemia are initially asymptomatic. If left untreated, most of the patients with smouldering adult T cell leukemia will develop steroid-responsive skin rash and multiple lung infiltrates.
Complications
- Common complications of adult T-cell leukemia include:[2]
- Cardiac arrhythmias (due to hypercalcaemia)
- Opportunistic infections (due to defective a immune system)
- Bone fractures (due to lytic bone lesions)
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.[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%.
| Prognostic Factor | Description |
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| Clinical subtype |
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| Age |
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| Performance status |
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| Calcium level |
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| Leukocyte count |
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| Lactate dehydrogenase (LDH) level |
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| β2-microglobulin level |
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| Lymphocyte surface markers |
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| 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.
- ↑ 2.0 2.1 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 3.2 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.
- ↑ 4.0 4.1 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.