title: A case of post-transplant adult T-cell leukemia/lymphoma presenting myelopathy similar to but distinct from human T-cell leukemia virus type I (HTLV- I)-associated myelopathy.
abstract: BACKGROUND
  Adult T-cell leukemia/lymphoma (ATL) responds poorly to conventional chemotherapy, but allogeneic stem cell transplantation (allo-SCT) may improve disease prognosis. Herein, we report a female patient with human T-cell leukemia virus type I (HTLV-I)-associated myelopathy (HAM)-like myelopathy following allo-SCT for ATL.
  
  
  METHODS
  She developed crural paresis 14 months after allo-SCT. Initially, she was diagnosed with central nervous system (CNS) relapse of ATL and treated with intrathecal injection and whole brain and spine irradiation. Her symptoms recurred 5 months later, when a cerebrospinal fluid (CSF) specimen showed increased CD4 + CXCR3 + CCR4+ cell numbers and levels of neopterin and CXCL10 (IP-10).
  
  
  CONCLUSIONS
  These results suggest the possible involvement of a certain immunological mechanism such as HAM in her symptoms, irrespective of the lack of anti-HTLV-I antibody in her CSF. Because a definitive diagnosis of CNS manifestation of ATL is sometimes difficult, multi-modal laboratory data are required for differential diagnosis.
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Toyotaka
authors.initials: T
authors.lastname: Kawamata
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ohno
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan ; Division of Molecular Therapy, Department of The advanced Clinical Research Center, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan ; Division of Molecular Therapy, Department of The advanced Clinical Research Center, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Norihide
authors.initials: N
authors.lastname: Jo
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.affiliation: Department of Blood Transfusion and Cellular Therapy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.affiliation: Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University Graduate School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8512 Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Yamano
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan ; Division of Molecular Therapy, Department of The advanced Clinical Research Center, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Arinobu
authors.initials: A
authors.lastname: Tojo
authors.affiliation: Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, the University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639 Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Uchimaru
keywords: Adult T-cell leukemia/lymphoma; CXCL10 (IP-10); HTLV-I-associated myelopathy (HAM); Neopterin; Post-transplant myelopathy