Implication of HTLV-I infection, strongyloidiasis, and P53 overexpression in the development, response to treatment, and evolution of non-Hodgkin's lymphomas in an endemic area (Martinique, French West Indies)
P. Agape et al., Implication of HTLV-I infection, strongyloidiasis, and P53 overexpression in the development, response to treatment, and evolution of non-Hodgkin's lymphomas in an endemic area (Martinique, French West Indies), J ACQ IMM D, 20(4), 1999, pp. 394-402
A clinicopathologic study was conducted to assess the implication of HTLV-I
infection, Strongyloides stercoralis (Ss) infection? and P53 overexpressio
n in the development, response to treatment, and evolution of non-Hodgkin's
lymphoma (NHL) in Martinique, French West Indies. Two groups of patients,
with 22 and 41 participants with B-cell and T-cell lymphoma, respectively,
were analyzed. HTLV-I antibodies were detected in 24 (59%) patients with T-
cell lymphoma of whom 19 (46%) fulfilled diagnostic criteria of adult T-cel
l leukemia/lymphoma (ATLL). By comparison with other T-cell lymphomas, pati
ents with ATLL were significantly younger (52 versus 63 years; p = .03), ha
d a significantly higher incidence of hypercalcemia (60% versus 0%; p = .00
01), a trend for higher incidence of digestive tract localization (21% vers
us 4%; p = .1 and significantly shorter median survival (6 versus 17 months
; p = .03). Similar results were observed when all 24 HTLV-I-infected patie
nts with T-cell lymphoma were compared with the 17 seronegative patients. S
trongyloidiasis was diagnosed in 11 of 33 patients tested for Ss infection.
All 4 Ss-infected (Ss-positive) ATLL patients treated with combination che
motherapy achieved complete remission (CR) versus only 2 of 7 Ss-negative A
TLL patients (p = .04). Ln addition, survival of Ss-positive patients with
ATLL was better than that of the uninfected patients: 27 versus 5 months, p
= .04, respectively). P53 expression was assessed by immunohistochemistry
on lymph node biopsies from 37 patients including Is B-cell lymphomas, 14 A
TLL, and 5 other T-cell lymphomas. P53 overexpression (P53-positive) was ob
served in 6 samples that corresponded in all 6 patients with ATLL. All P53-
positive ATLL patients had stage TV disease with elevated lactate dehydroge
nase (LDH) levels. By comparison with other ATLL patients studied for p53 e
xpression P53-positive ATLL were characterized by a lower response rate to
combination chemotherapy (CR: 0 of 6 versus 4 of 6; p = .04) and a shorter
survival (2 versus 9 months, p = .04). Our results suggest that ATLL repres
ents almost 50% of T-cell lymphomas in Martinique: Ss infection during ATLL
seems to be linked with a high response rate to chemotherapy and prolonged
survival; and P53 overexpression is observed in almost 50% of aggressive A
TLL from Martinique and, even in advanced clinical subtypes, is associated
with resistance to chemotherapy and short-term survival.