Table 1.

Diagnosis and classification of ATL

SubtypeAsymptomatic HTLV-1 carrierSmolderingChronicAcuteLymphoma
HTLV-1 serology 
Monoclonal integration of provirus − + (lymph node) 
Lymphocyte count Normal Normal Elevated Elevated Normal 
Percentage circulating abnormal lymphocytes <5% ≥5% or <5% if ATL skin and lung lesions present ≥5% ≥5% ≤1% 
Hypercalcemia − − − Normal or high Normal or high 
LDH Normal Normal or ≤1.5 ULN Normal or <2 ULN Normal or high Normal or high 
Skin or lung involvement − 
Bone marrow or splenic involvement − − 
Bone, gastrointestinal, or CNS involvement − − − 
SubtypeAsymptomatic HTLV-1 carrierSmolderingChronicAcuteLymphoma
HTLV-1 serology 
Monoclonal integration of provirus − + (lymph node) 
Lymphocyte count Normal Normal Elevated Elevated Normal 
Percentage circulating abnormal lymphocytes <5% ≥5% or <5% if ATL skin and lung lesions present ≥5% ≥5% ≤1% 
Hypercalcemia − − − Normal or high Normal or high 
LDH Normal Normal or ≤1.5 ULN Normal or <2 ULN Normal or high Normal or high 
Skin or lung involvement − 
Bone marrow or splenic involvement − − 
Bone, gastrointestinal, or CNS involvement − − − 

−, negative; +, positive; CNS, central nervous system; ULN, upper limit of normal.

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