A case of adult T-cell leukemia induced to remission with total body irradiation

A 50-year-old man was admitted to the hospital in July, 1981 because of general amlaise, lymphadenopathy, hepatosplenomegaly and generalized trichophytosis. His white blood cell count was 177,000/cmm and peripheral blood smear showed marked increase of abnormal lymphoid cells with convoluted nuclei, which were compatible with adult T-cell leukemia. His chest X-ray films revealed pulmonary infiltration in both lower lung fields. Abdminal computed tomography showed multiple low density areas in the liver, suggesting leukemic infiltration. He was treated with total body irradiation as a primary therapy. Daily doses of 10 rad were given 5 times a week by using Linac, Mitsubishi ML III. A total dose of 150 rad was administered over a period of three weeks. Abnormal lymphoid cells in the peripheral blood rapidly decreased although significant pancytopenia developed as well. About a month after the completion of total body irradiation, he entered the complete remission with normalization of peripheral and bone marrow pictures. His remission continued over sixteen months without any maintenance therapy. Most of the ATL patients are lost for a short period of time following multi-agent chemotherapy and/or conventional irradiation therapy. The clinical course of this patient suggests that total body irradiation could be a primary treatment of choice for adult T-cell leukemia patients. (author)