POSSIBLE ASSOCIATION BETWEEN ADULT T-CELL LEUKEMIA LYMPHOMA AND ACUTEMYELOID-LEUKEMIA/

BACKGROUND. To the authors' knowledge, an association between adult T- cell leukemia/lymphoma (ATL) and acute myeloid leukemia (AML) has been reported only in four patients. The authors identified five additiona l patients with both neoplasms. METHODS. A review of the clinical reco rds of patients with AML, ATL, or lymphoid neoplasms other than ATL di agnosed between 1986 and 1995 was performed. Cytokine levels were assa yed in selected patients. The authors searched for reports from other institutions using MEDLINE and the proceedings of two Japanese hematol ogy societies. RESULTS. ATL was diagnosed in 134 patients, whereas 180 had AML. Five patients with both neoplasms were identified (3.7% of A TL patients and 2.8% of AML patients). In seven of the nine patients ( including four patients in the literature) with ATL and AML, the ATL w as diagnosed prior to the AML, whereas in the remaining two patients b oth neoplasms were diagnosed simultaneously. Six of the nine cases wer e therapy-related (t)-AML, which developed after chemotherapy for ATL. Monoclonal integration of proviral human T-lymphotropic virus type 1 was detected in ATL cells but not in AML cells in the six patients exa mined. The plasma levels of macrophage colony-stimulating factor (M-CS F), granulocyte-colony stimulating factor, and granulocyte-macrophage- colony stimulating factor (GM-CSF) were elevated in 3, 1, and 1, respe ctively, of the 4 patients examined at AML onset who had active ATL. I n one case, the levels of several cytokines, including GM-CSF and M-CS F, in the supernatant fluid of short term cultured ATL cells were elev ated. Three patients with de novo ATL and AML received remission induc tion therapy, and two achieved a complete remission (CR) of both disea ses. Among the four patients who received chemotherapy for t-AML, two achieved CR. CONCLUSIONS. ATL patients also can develop AML, irrespect ive of treatment with chemotherapy for ATL. This association does not indicate exclusive chemoresistance of both neoplasms. Cytokines produc ed by ATL cells may support the growth of AML cells. (C) 1998 American Cancer Society.