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Published: December 2010

Open Access Gateway

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.

Author affiliations

Division of Hematology and Oncology, Brookdale University Hospital and Medical Center, Brooklyn, N.Y., USA

Corresponding Author

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

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Case Rep Oncol 2010;3:489–494

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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.

© 2011 S. Karger AG, Basel

Article / Publication Details

First-Page Preview
Abstract of Published: December 2010

Published online: December 21, 2010
Issue release date: September – December

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 0

eISSN: 1662-6575 (Online)

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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.
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