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Blood, Vol. 92 No. 10 (November 15), 1998:
pp. 3557-3561
Risk Factors for Adult T-Cell Leukemia Among Carriers of Human
T-Lymphotropic Virus Type I
Michie Hisada,
Akihiko Okayama,
Shigemasa Shioiri,
Donna L. Spiegelman,
Sherri O. Stuver, and
Nancy E. Mueller
From the Departments of Epidemiology and Biostatistics, Harvard
School of Public Health, Boston, MA; and the Second Department of
Internal Medicine, Miyazaki Medical School, Miyazaki, Japan.
The presence of circulating "flower cells" and a low
prevalence of antibody to Tax regulatory protein of human
T-lymphotropic virus type I (HTLV-I) are characteristics of adult
T-cell leukemia (ATL). To examine the predictability of levels of
HTLV-I antibodies and of flower cell-like abnormal lymphocytes (Ably)
for the risk of ATL among asymptomatic HTLV-I carriers, we
prospectively evaluated the levels of viral markers of five HTLV-I
carriers who developed ATL and 38 age-, sex-, and screen-matched
HTLV-I-positive controls in the Miyazaki Cohort Study. After
accounting for matching factors, Ably level was slightly, but not
significantly, higher among cases than among controls (P = .13). Anti-HTLV-I (odds ratio [OR] = 1.6 per twofold dilution;
95% confidence interval [CI] 0.94, 3.8) was associated with ATL
diagnosis, but antibody to Tax regulatory protein (anti-Tax) was not
(OR = 0.78; 95% CI 0.26, 1.7). Anti-Tax level was low for all ATL
cases for up to 10 years preceding their diagnosis, independent of the
level of anti-HTLV-I titer. HTLV-I carriers with a higher anti-HTLV-I
titer and a lower anti-Tax reactivity may be at greatest risk of ATL.
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