Adult 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 disease|natural history]] of adult T-cell leukemia varies between the different | The [[Natural history of disease|natural history]] of adult T-cell leukemia varies between the different sub-types 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 sub-types of adult T-cell leukemia. Acute and lymphomatous sub-types have a poor [[prognosis]]; whereas, chronic and smoldering sub-types have a good [[prognosis]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* The [[Natural history of disease|natural history]] of adult T-cell leukemia varies between the different | * The [[Natural history of disease|natural history]] of adult T-cell leukemia varies between the different sub-types 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> | ||
* Patients with '''acute''' adult T-cell leukemia usually 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]]. | * Patients with '''acute''' adult T-cell leukemia usually 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]]. | ||
* Patients with '''chronic''' adult T-cell leukemia will usually 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. | * Patients with '''chronic''' adult T-cell leukemia will usually 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. | ||
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===Prognosis=== | ===Prognosis=== | ||
* The [[prognosis]] varies between the | * The [[prognosis]] varies between the sub-types of adult T-cell leukemia. Acute and lymphomatous sub-types have a poor [[prognosis]]; whereas, chronic and smoldering sub-types 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 adult T-cell leukemia is approximately 16%. | :* The 4-year overall survival rate of patients with adult T-cell leukemia is approximately 16%. | ||
:* 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 '''acute''' adult T-cell leukemia is approximately 11%. | ||
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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 sub-types of the disease. Common complications of adult T-cell leukemia include cardiac arrhythmias, opportunistic infections, and bone fractures. The prognosis varies between the sub-types of adult T-cell leukemia. Acute and lymphomatous sub-types have a poor prognosis; whereas, chronic and smoldering sub-types have a good prognosis.
Natural History, Complications, and Prognosis
Natural History
- The natural history of adult T-cell leukemia varies between the different sub-types of the disease.[1]
- Patients with acute adult T-cell leukemia usually 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.
- Patients with chronic adult T-cell leukemia will usually 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
- Cardiac arrhythmias (due to hypercalcemia)
- 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 sub-types of adult T-cell leukemia. Acute and lymphomatous sub-types have a poor prognosis; whereas, chronic and smoldering sub-types have a good prognosis.[3]
- The 4-year overall survival rate of patients with adult T-cell leukemia is approximately 16%.
- 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 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]
| Prognostic Factor | Description |
|---|---|
| Clinical subtype |
|
| Gender |
|
| Performance status |
|
| Calcium level |
|
| Leukocyte count | |
| Lactate dehydrogenase (LDH) level | |
| β2-microglobulin level |
|
| Lymphocyte surface markers | |
| 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.
- ↑ 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.