title: Treatment of adult T-cell leukaemia/lymphoma: is the virus a target?
abstract: OBJECTIVE
  To discuss current understanding of the mechanisms of human T-lymphotropic virus type-1 (HTLV-1) tumorigenesis and current and potential treatment strategies for adult T-cell leukaemia/lymphoma (ATL), an aggressive malignant disease of CD4 cells caused by HTLV-1.
  
  
  RESULTS
  Treatment of the aggressive subtypes of ATL remains inadequate, with little improvement in overall survival in the 30 years since HTLV-1 was discovered. Detailed analysis of the clonal expansion of HTLV-1 has provided new insight into pathogenesis. Most HTLV-1-infected cells, including ATL, express CCR4 which can be targeted. Reports of antitumour effects with allogeneic bone marrow transplantation provide a rationale for novel immunotherapy approaches. Progress has been made in the indolent subtypes of ATL with the use of 'antiviral' therapies.
  
  
  CONCLUSIONS
  ATL has poor prognosis. There is a major, urgent, unmet clinical need to identify HTLV carriers who will develop ATL to develop biomarkers of transforming disease and disease progression and to provide novel treatment approaches within the context of clinical trials. Several strategies now include putative or actual antiviral therapy. Potentially, the risk of ATL would be reduced by eliminating some or all infected clones. HTLV-1 infection, and hence ATL, can be prevented by antenatal HTLV-1 screening.
authors.affiliation: aSection of Virology, Department of Medicine, Imperial College London bDepartment of Medicine, National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: Lucy B
authors.initials: LB
authors.lastname: Cook
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D003131:Combined Modality Therapy; D015490:HTLV-I Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D015368:Human T-lymphotropic virus 1 / Q000187:drug effects*; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome