Adult T-Cell Leukemia and Lymphoma

Identification of the Diagnostic Testing for the Disease or Disorder

The process of diagnosing adult T-cell Leukemia/Lymphoma (ATLL) assumes a systematic approach. This approach is necessary because ATLL is characterized by clinical features that are akin to several other closely related disorders such as lymphatic leukemia, mycosis fungoides, non-Hodgkin’s lymphoma, and Hodkin’s disease (Huang et al., 2014). Additionally, ATLL is broadly classified into four variants based on severity.

Its variants include pre-leukemic ATLL, smoldering ATLL, chronic ATLL, and sub-acute or acute ATLL (Huang et al., 2014). Due to its heterogeneity and close association with other leukemic disorders, the diagnosis of ATLL calls for a cautious approach as it can easily confuse physicians.

Adult patients who exhibit typical clinical features associated with leukemic disorders and have circulating neoplastic lymphocytes with pleomorphic nuclear lobulations are highly likely to be ATLL victims (Qayyum & Choi, 2014). If these features are observed in a patient, a confirmation is needed to determine if the patient is a victim of ATLL. The confirmation is done through HTLV‐I serology, which is a test that determines whether malignant lymphocytes that exist in a patient’s blood have mature T-helper cells (Qayyum & Choi, 2014). This test also determines whether HTLV‐I proviral DNA sequences are demonstrable.

It is important to note that most patients with leukemic disorders test seropositive and as such, a more advanced technique may sometimes be required to ascertain the presence of HTLV‐I sequences (Qayyum & Choi, 2014). The most commonly applied technique is the polymerase chain reaction. Some additional diagnostic features that distinguish ATLL from other leukemic disorders include typical peripheral malignant lymphocytes, immunologic markers, and typical T-β-chain gene rearrangement.

Explanation of the Clinical Management and the Effect of the Pathophysiology of the Disease

The treatment of ATLL also pays close attention to the four variants of the disorder. Typically, patients with pre-leukemic ATLL, smoldering ATLL, and chronic ATLL may not need any medication (Huang et al., 2014). The disease becomes an issue of concern when it advances to the sub-acute or acute stage. This stage is dangerous and needs aggressive treatment. Treatment includes aggressive chemotherapy, radiotherapy, or both (Huang et al., 2014). Other treatment regimens have been tried, but they often lead to relapses. Patients may relapse to their initial state or other disorders such as the leptomeninges (Huang et al., 2014).

The disorder’s rate of response to treatment is low and in most cases, short-lived. Some advances have been made in its treatment in the last decade. The introduction of antiretroviral zidovudine and interferon-alpha is a new development that proved to be more effective than traditional treatment regimens. However, research is still ongoing to perfect the use of this treatment since much is yet to be learned about it (Huang et al., 2014). Stem-cell transplantation is another relatively new treatment for ATLL that has emerged in the recent past, but it is only applicable to young patients (Qayyum & Choi, 2014).

ATLL’s mortality rates are relatively high because about 50% of its victims die. The disease severely reduces the immune system of its victims, leaving them vulnerable to opportunistic infections (Qayyum & Choi, 2014). Treatment with thiabendazole or albendazole is recommended in cases where a patient’s immune system has been compromised.

Knowledge about ATLL’s treatment has improved notably in the recent past. Nonetheless, it is one of the diseases whose outlook remains dismal (Huang et al., 2014). Research is ongoing and better treatment regimens may be developed in the future, but at the moment, emphasis should be on how to use existing treatment regimens effectively.

References

Huang, C. T., Lee, Y. H., Chow, K. C., Yang, C. F., Chen, P. H., Hsiao, L. T., &… Chiou, T. J. (2014). Adult T-cell leukemia/lymphoma can mimic other lymphomas in a non-endemic area: Dilemmas in diagnosis and treatment. Internal Medicine Journal, 44(4), 374-383. Web.

Qayyum, S., & Choi, J. K. (2014). Adult T-Cell Leukemia/Lymphoma. Archives of Pathology & Laboratory Medicine, 138(2), 282-286. Web.