Nodal T‐cell lymphoma in an HTLV‐I‐endemic area: proviral HTLV‐I DNA, histological classification and clinical evaluation

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Abstract

<jats:p>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‐I 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.</jats:p><jats:p>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.</jats:p>

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