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Vol. 3, No. 3, 2010
Issue release date: September – December
Open Access Gateway
Case Rep Oncol 2010;3:489–494
(DOI:10.1159/000323163)
Published: December 2010

Dual-Positive (CD4+/CD8+) Acute Adult T-Cell Leukemia/Lymphoma Associated with Complex Karyotype and Refractory Hypercalcemia: Case Report and Literature Review

Raza S. · Naik S. · Kancharla V.P. · Tafera F. · Kalavar M.R.
Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, N.Y., USA

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.

 goto top of outline Author Contacts

Madhumati R. Kalavar, MD
Department of Hematology and OncologyBrookdale University Hospital and Medical Center
1 Brookdale Plaza, Brooklyn, NY 11212 (USA)
Tel. +1 718 240 6208, Fax +1 718 240 6347, E-Mail mkalavar@brookdale.edu


 goto top of outline Article Information

Published online: December 21, 2010
Number of Print Pages : 6
Number of Figures : 1,


 goto top of outline Publication Details

Case Reports in Oncology

Vol. 3, No. 3, Year 2010 (Cover Date: September - December)

Journal Editor: Markman M. (Philadelphia, Pa.)
ISSN: NIL (Print), eISSN: 1662-6575 (Online)

For additional information: http://www.karger.com/CRO


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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