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Epidemiology and Immunovirology of Human T-Cell Leukemia/Lymphoma Virus Type I-associated Adult T-Cell Leukemia and Chronic Myelopathies as Seen in France¹

CNRS Laboratory of Epidemiology and Immunovirology of Tumors, Faculté de Médicine Alexis Carrel, 69372 Lyon Cedex 8, France [A. G., G. d-T.]; UPR 0043 CNRS, St. Louis Hospital, 75010 Paris, France [A. G., F. S., J. P.]; Molecular Hematology Laboratory and Central Hematology Laboratory, St. Louis Hospital, 75010 Paris, France [A. G., M. T. D., G. F., F. S.]; Neurology and Neuropsychology Clinic, Pitié-Salpétrière Hospital, 75013 Paris, France [O. G., O. L-C.]; and Hematology Department, Hotel Dieu, 75004 Paris, France [B. R.]

Seventeen patients with adult T-cell leukemia (ATL) and 21 with tropical spastic paraparesis/human T-cell leukemia/lymphoma virus type I (HTLV-I)-associated myelopathy (TSP/HAM) were observed during a 3-yr survey (1986–1988) in some hospitals in Paris, France. Most of them were black, originating from high-HTLV-I-endemic areas (West Indies or Africa), but two cases of TSP/HAM occurred in French Caucasians. In one case, the patient acquired the virus from a transfusion during a cardiac transplantation. Most of the ATL cases were diagnosed as acute leukemia or lymphoma, with a proliferation of CD2+, CD3+, CD4+, CD8-, DR+, and CD25+ lymphoid cells. Only three cases were diagnosed as a smoldering ATL. All of the TSP/HAM cases exhibited a spastic paraparesis with a chronic and slow evolution and high HTLV-I antibody titers in serum and cerebrospinal fluid, with a high HTLV-I antibody index and specific HTLV-I immunoglobulin = oligoclonal bands. In TSP/HAM, a high percentage of DR-expressing cells (15 to 40%) was found, with a slightly elevated CD4/CD8 ratio. This was associated with the presence of 1 to 10% abnormally shaped nuclei in lymphoid cells and a polyclonal integration of HTLV-I proviruses in these peripheral blood mononuclear cells. On the contrary, a clonal integration was always found in the ATL malignant cells (leukemic, lymph node, and cutaneous infiltrate). Long-term interleukin 2-dependent T-cell lines (CD2+, CD3+, CD4+, and WT31+) with activated T-cell markers (CD25+ and DR+) producing HTLV-I were established from ATL and TSP/HAM peripheral blood mononuclear cells.