Anti-human T-cell lymphotrophic virus type I antibody-positive adult T-cell leukemia/lymphoma with no monoclonal proviral DNA. A clinicopathologic and immunologic study

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Abstract
Proviral DNA of adult T‐cell leukemia virus (HTLV‐I) was examined by the standard Southern blotting method in lymph nodes of 45 patients with anti‐HTLV‐I antibody (ATLA)‐positive adult T‐cell leukemia/lymphoma (ATLL). Six of these patients revealed no monoclonal proviral HTLV‐I DNA in tumor cells. These six patients showed typical flower cells in peripheral blood; they comprised five cases of the smoldering type and one of lymphoma type. They showed a longer clinical course than ATLL patients with integrated proviral HTLV‐I DNA. Five of the six patients were alive from 8 to 36 months after onset; the other patient died 9 months after onset. Histologically, they exhibited features of T‐cell malignancy but with absence of the typical cerebriform giant cells that are usually present in ATLL. The tumor cells represented T‐cell markers, usually CD4, but CD25 was negative. Rearrangement of the T‐cell receptor gene Cβ was found in four of the six cases. On the basis of these results, cases of ATLL with no monoclonal proviral HTLV‐I DNA should be clinicopathologically differentiated from those with integrated proviral DNA. Cancer 64:2515–2524, 1989.