Adult T-Cell Leukemia/Lymphoma in Peru: A Report of 120 Cases

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive subtype of peripheral T-cell lymphoma associated with the human T-cell lymphotropic virus type-I (HTLV-1). ATLL follows a specific geographic pattern and is more frequently seen in Southern Japan, the Caribbean basin, the Middle East and South America. This retrospective study attempts to describe the characteristics and define prognostic factors for patients with ATLL in Peru.

We included consecutive cases of ATLL identified at our institution between January 1997 and January 2012. Diagnosis of ATLL was based on clinical history and histological findings consistent with ATLL, and either a positive HTLV-1 serology or evidence of HTLV-1 integration in the pathological sample. We used the Shimoyama classification to differentiate among ATLL subtypes. Patients' characteristics will be presented descriptively. For the univariate analysis, overall survival (OS) curves were estimated using the Kaplan-Meier method, and compared using the log-rank test.

We have included 120 patients who met the criteria for ATLL. The median age was 61 years (range 23–92 years), and 46% of patients was >60 years. The male-to-female ratio was 1. 2:1. ATLL types were acute in 49 (40%), lymphomatous in 53 (44%), cutaneous in 12 (10%), smoldering in 3 (3%) and chronic in 3 (3%) patients. An ECOG performance status >1 was seen in 51%, B symptoms were reported in 63%, stage III/IV in 85%, bone marrow involvement in 46%, and LDH was increased in 87% of the cases. An IPI score 0–2 was reported in 31% and score 3–5 in 69% of patients. Lymphocyte count <1000/uL occurred in 38% and monocyte count >1000/uL was in 33% of the cases. Chemotherapy was administered in 82% of patients, 18% could not receive treatment due to a bad performance status. The median OS for the entire group was 5. 5 months. Acute ATLL had a significantly shorter OS than lymphomatous (p<0. 001). A high IPI score (score 3–5) was associated with a shorter OS (p=0. 01).

ATLL is a heterogeneous disease with distinct clinical features and outcomes. Based on our series, which represents the largest Latin-American cohort, acute had a worse prognosis than lymphomatous ATLL, and the IPI score should be used for risk-stratification.

No relevant conflicts of interest to declare.