Leucemia/limfomul cu celula T a adultului - forma acuta - atitudine terapeutica si prognostic

  Autori: Diana Cisleanu, Mihaela Dervesteanu, Cristina Ciufu, Horia Bumbea,
Madalina Begu, Sanziana Radesi, Minodora Onisai, Ana Maria Vladareanu**, Victoria Arama*  

Leucemia/limfomul cu celula T a adultului reprezinta o neoplazie a limfocitului T periferic cu etiologie virala: retrovirusul HTLV-I (human T cell lymphotropic virus Type I). Calea de transmitere a infectiei: de la mama la nou nascut prin alaptare, transmitere sexuala, prin transfuzii necontrolate si consumul de droguri injectabile. Diagnosticul infectiei se realizeaza prin detectarea anticorpilor antiproteine virale prin teste precum ELISA (screning), LIA, Western-Blot (confirmare). Au fost descrise patru forme clinice: acuta, limfomatoasa, cronica si indolenta. ATLL reprezinta o afectiune cu prognostic rezervat datorita rezistentei celulelor leucemice la chimioterapie si a imunosupresiei cauzata atat de virus, cat si de chimioterapie. Alternativele terapeutice cunoscute in prezent sunt: chimioterapia conventionala si intensiva urmata de transplant medular allogenic de celula stem, terapie antiretrovirala si interferon, trioxid de arseniu As2O3, acid transretinoic, anticorpi monoclonali antiTac.

Cuvinte cheie: ATLL, HTLV-I 

Abstract:

Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell neoplasia caused by the human Tcell lymphotropic virus type I (HTLV- I). The virus transmission could be from the mother to the newborn by breastfeeding, sexual intercourse, transfusions and parenteral way. The presence of the virus infection is detected by using ELISA as screening assay, LIA (line immunoassay) or Western Blot assay in order to confirm. ATLL has four clinical subtypes: acute, chronic, lymphomatous and smoldering. The disease is associated with a poor prognosis because of the drug resistance to chemotherapy and the immunosupression caused by virus infection and therapy. New therapeutically approaches include: conventionally and intensive chemotherapy followed by allogenic transplantation, a combination of INF-a and antiretroviral therapy, As2O3, all-trans retinoic acid, anti Tac monoclonal antibodies.

Key words:  ATLL, HTLV-I

Dr. Diana Cisleanu, Dr. Mihaela Dervesteanu, Dr. Cristina Ciufu, Dr. Horia Bumbea, Dr. Madalina Begu, Sanziana Radesi, Minodora Onisai, Conf. dr. Ana Maria Vladareanu**, Conf. dr. Victoria Arama*

*Institutul de Boli Infectioase “Matei Bals”

**Clinica de Hematologie Spitalul Universitar de Urgenta Bucuresti