Dual-positive (CD4+/CD8+) acute adult T-cell leukemia/lymphoma associated with complex karyotype and refractory hypercalcemia: Case report and literature review

Shahzad Raza, Seema Naik, Venkat P. Kancharla, Fekade Tafera, Madhumati R. Kalavar

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

We describe a rare case of adult T-cell leukemia characterized by an expansion of CD4+ CD8+ double-positive lymphocytes associated with human T-lymphotropic virus type 1 (HTLV-1) and a complex karyotype in a 43-year-old Caribbean male who was initially admitted to our hospital with significant lethargy, visual disturbances, dysphagia, right facial palsy and numbness in both feet for 3 days. He was found to have severe hypercalcemia (15.6 mg/dl). Peripheral blood smear showed multilobulated clover-shaped nuclei. Bone marrow and CSF flow cytometries revealed abnormal monoclonal expansion of T cells positive for CD4, CD5, CD8 and CD25 but negative for CD7, CD20, CD56, CD68 and terminal deoxynucleotidyl transferase. The polymerase chain reaction analysis showed a distinct band of the T-cell receptor γ gene, revealing T-cell clonal integration of the proviral DNA of HTLV-1, thus confirming the diagnosis of acute adult T-cell leukemia/lymphoma. Cytogenetic study revealed a male karyotype with monosomy 12, unbalanced translocation 5q and 13q and additional material on 5q, 7q, 14q and 17q. The patient underwent prednisone (EPOCH) chemotherapy followed by autologous transplantation with BEAM regimen. Although patients with a rare mixed CD4+ CD8+ immunophenotype usually present with an aggressive clinical course and have a poor prognosis, our patient was able to survive for 2.5 years.

Original languageEnglish (US)
Pages (from-to)489-494
Number of pages6
JournalCase Reports in Oncology
Volume3
Issue number3
DOIs
StatePublished - Sep 1 2010

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Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Adult T Cell Leukemia Lymphoma
Hypercalcemia
Karyotype
Human T-lymphotropic virus 1
CD8-Positive T-Lymphocytes
T-Lymphocytes
Monosomy
T-Cell Receptor Genes
Medicago
Lethargy
DNA Nucleotidylexotransferase
Hypesthesia
Autologous Transplantation
Facial Paralysis
Deglutition Disorders
Prednisone
Cytogenetics
Foot
Flow Cytometry

All Science Journal Classification (ASJC) codes

  • Oncology

Cite this

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title = "Dual-positive (CD4+/CD8+) acute adult T-cell leukemia/lymphoma associated with complex karyotype and refractory hypercalcemia: Case report and literature review",
abstract = "We describe a rare case of adult T-cell leukemia characterized by an expansion of CD4+ CD8+ double-positive lymphocytes associated with human T-lymphotropic virus type 1 (HTLV-1) and a complex karyotype in a 43-year-old Caribbean male who was initially admitted to our hospital with significant lethargy, visual disturbances, dysphagia, right facial palsy and numbness in both feet for 3 days. He was found to have severe hypercalcemia (15.6 mg/dl). Peripheral blood smear showed multilobulated clover-shaped nuclei. Bone marrow and CSF flow cytometries revealed abnormal monoclonal expansion of T cells positive for CD4, CD5, CD8 and CD25 but negative for CD7, CD20, CD56, CD68 and terminal deoxynucleotidyl transferase. The polymerase chain reaction analysis showed a distinct band of the T-cell receptor γ gene, revealing T-cell clonal integration of the proviral DNA of HTLV-1, thus confirming the diagnosis of acute adult T-cell leukemia/lymphoma. Cytogenetic study revealed a male karyotype with monosomy 12, unbalanced translocation 5q and 13q and additional material on 5q, 7q, 14q and 17q. The patient underwent prednisone (EPOCH) chemotherapy followed by autologous transplantation with BEAM regimen. Although patients with a rare mixed CD4+ CD8+ immunophenotype usually present with an aggressive clinical course and have a poor prognosis, our patient was able to survive for 2.5 years.",
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Dual-positive (CD4+/CD8+) acute adult T-cell leukemia/lymphoma associated with complex karyotype and refractory hypercalcemia : Case report and literature review. / Raza, Shahzad; Naik, Seema; Kancharla, Venkat P.; Tafera, Fekade; Kalavar, Madhumati R.

In: Case Reports in Oncology, Vol. 3, No. 3, 01.09.2010, p. 489-494.

Research output: Contribution to journalReview article

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T1 - Dual-positive (CD4+/CD8+) acute adult T-cell leukemia/lymphoma associated with complex karyotype and refractory hypercalcemia

T2 - Case report and literature review

AU - Raza, Shahzad

AU - Naik, Seema

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AU - Kalavar, Madhumati R.

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