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Farre, LCorresponding Author

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January 11, 2024
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The importance of the clinical classification of adult T-cell leukemia/lymphoma (ATLL) in the prognosis

Publicated to: Plos Neglected Tropical Diseases. 16 (10): e0010807- - 2022-10-01 16(10), DOI: 10.1371/journal.pntd.0010807

Authors: Oliveira, PD; Ribeiro, GS; Anjos, RO; Dias, MA; Farre, L; Araújo, I; Bittencourt, AL

Affiliations

Bellvitge Inst Biomed Res IDIBELL, Catalan Inst Oncol ICO, ONCOBELL, Program Canc Therapeut Resistance ProCURE, Lhospitalet Del Llobrega, Catalonia, Spain - Author
Fundacao Oswaldo Cruz, Goncalo Moniz Inst, Lab Expt Pathol, Salvador, BA, Brazil - Author
Fundacao Oswaldo Cruz, Goncalo Moniz Inst, Lab Pathol & Mol Biol, Salvador, BA, Brazil - Author
Univ Fed Bahia, Dept Prevent & Social Med, Salvador, BA, Brazil - Author
Univ Fed Bahia, Prof Edgard Santos Teaching Hosp, Dept Internal Med, Salvador, BA, Brazil - Author
Univ Fed Bahia, Prof Edgard Santos Teaching Hosp, Dept Pathol, Salvador, BA, Brazil - Author
Univ Fed Sergipe, Dept Med, Aracaju, BA, Brazil - Author
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Abstract

Background Adult T-cell leukemia/lymphoma (ATLL), a peripheral T-cell leukemia/lymphoma associated with the human T-cell lymphotropic virus type-1 (HTLV-1), has been classified following the clinical forms defined by Shimoyama in 1991. A suggestion to modify Shimoyama's classification was proposed in 2007 to differentiate within the smoldering patients those who presented nodules or tumors in the skin without lung involvement, which was named the primary cutaneous tumoral (PCT) form of ATLL. In the present study, according to their clinicopathological characteristics, we estimated the mortality rates of 143 ATLL patients from Bahia, Brazil. We also evaluated the importance of classifying PCT/ATLL separately from the smoldering type on disease prognosis. Methodology/Principal findings Diagnosis of ATLL was established based on a positive serology for HTLV-1, histopathological and/or cytological diagnosis of peripheral T-cell leukemia/lymphoma. Patients were clinically grouped according to Shimoyama's classification, considering PCT variants separately from the smoldering cases. Bivariate and multivariable survival analyses were applied to identify factors associated with disease prognosis. Significant differences in the median survival time were observed between the clinical types, with the smoldering type presenting the longest median survival (109 months) compared to the other forms (< 50 months); the median survival for PCT/ATLL was 20 months. Multivariable analysis confirmed that ATLL clinical types were associated with survival, with a better prognosis for patients with the smoldering and chronic types. Furthermore, skin involvement was related a worse outcome in the multivariable analysis, regardless of the clinical form and presence of lymphadenopathy. Conclusions/Significance Our results reinforce the importance of considering the PCT/ATLL separately from the smoldering type when classifying ATLL to better define prognosis and treatment, given the significant difference in the survival of patients between the smoldering form and PCT/ATLL. Skin involvement should also be considered an independent prognostic factor in patients with ATLL.

Keywords

AdultAdult t cell leukemiaAllogeneic hematopoietic stem cell transplantationAllogeneic stem cell transplantationAlpha interferonAmericaAnaplastic large cell lymphomaArticleBlood biochemistryBlood cell countBlood smearBone marrow biopsyCalciumCalcium blood levelCancer prognosisCerebrospinal fluidComplicationComputer assisted tomographyCriteriaCytodiagnosisEchographyEnzyme linked immunosorbent assayErythrodermaFeaturesFemaleFollow upHepatomegalyHistopathologyHumanHuman t-lymphotropic virus 1Human tissueHumansHypercalcemiaImmunohistochemistryImmunophenotypingIntegrationInverse polymerase chain reactionLeukemia-lymphomaLeukemia-lymphoma, adult t-cellLymphadenopathyLymphocyte countLymphocytosisLymphomaMajor clinical studyMaleMycosis fungoidesPathologyPolymerase chain reactionPrognosisQuestionnaireRetrospective studySkinSpastic paraplegiaSplenomegalySurvivalT cell leukemiaThorax radiographyWestern blottingZidovudine

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Plos Neglected Tropical Diseases due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 2/24, thus managing to position itself as a Q1 (Primer Cuartil), in the category Tropical Medicine. Notably, the journal is positioned above the 90th percentile.

Independientemente del impacto esperado determinado por el canal de difusión, es importante destacar el impacto real observado de la propia aportación.

Según las diferentes agencias de indexación, el número de citas acumuladas por esta publicación hasta la fecha 2025-12-13:

  • WoS: 5
  • Scopus: 5

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-12-13:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 20.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 20 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Brazil.

the author responsible for correspondence tasks has been FARRE VALLVE, MARIA LOURDES.

Awards linked to the item

The study was supported by the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq, www.cnpq.br): (1) 409985/2016-3 (ALB) and (2) 310249/2017-1 (LF) and by the Fundacao de Apoio a Pesquisa do Estado da Bahia (FAPESB, www.fapesb.ba.gov.br), Brazil: (1) PNX0008/2014/Fapesb, (2) Edital 08/2014 -PANE (ALB) and (3) RED0028/2012 (LF). GSR receives a research scholarship award from Conselho Nacional de Desenvolvimento Cientifico e Tecnologico. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.