Adult T-cell leukemia/lymphoma in the Middle East: first report of two cases from Lebanon.
BACKGROUND
Adult T-cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disorder caused by human T-cell leukemia virus type I (HTLV-I). HTLV-I is endemic in southern Japan, the Caribbean, Central and South America, certain areas of Africa, and the southeastern United States. In the Middle East, North East Iran, particularly the region of Mashhad, has been recognized as an endemic region.


METHODS
In this report, the first two cases of ATL diagnosed in Lebanon are described. The first patient of Lebanese origin presented with acute ATL. The second patient of Romanian origin developed acute ATL in early relapse after autologous transplantation for ATL. Both patients had lymphocytosis, severe hypercalcemia, and CD25+ T-cell immunophenotype on peripheral blood. In both patients, HTLV-I serology was positive by enzyme-linked immunosorbent assay and confirmed by Western blot and HTLV-I oncoprotein Tax expression was documented in the leukemic cells. Upon screening, seven direct family members of the first patient were HTLV-I positive; four of them were regular blood donors.


CONCLUSIONS
Screening blood donors for HTLV-I seropositivity is not currently performed in Lebanon. A large screening study in Lebanon is needed to confirm whether South Lebanon is a new endemic region for HTLV-I infection and to recommend mandatory screening of blood donors for HTLV-I infection.
Bitar
Nizar
N
Hematology Oncology, Transfusion Medicine, Sahel Hospital, Lebanese University, Beirut, Lebanon. nbitar@inco.com.lb
Hajj
Hiba El
HE
Houmani
Zaher
Z
Sabbah
Ahmad
A
Otrock
Zaher K
ZK
Mahfouz
Rami
R
Zaatari
Ghazi
G
Bazarbachi
Ali
A
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D016356:Gene Products, tax / Q000097:blood; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007861:Lebanon; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology*; D008875:Middle Aged; D015215:Zidovudine / Q000627:therapeutic use; D000077211:Zoledronic Acid
D000998:Antiviral Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D016356:Gene Products, tax; D007093:Imidazoles; D016898:Interferon-alpha; D015215:Zidovudine; D000077211:Zoledronic Acid