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months70,74; one of whom demonstrated undetectable proviral load in the peripheral blood mononuclear cells by PCR analysis.74

Evaluation of transplantation data is complicated by heterogeneity in patient selection, choice of conditioning regimen, source of stem cells, degree of antigen mismatch, and HTLV-1 status of donors. For both myeloablative and nonmyeloablative allogeneic stem cell transplantations, the optimal conditioning regimen, source of stem cells (bone marrow vs peripheral blood), and type of GvHD prophylaxis are unclear. The use of HTLV-1-seropositive, but disease-free, donors is also uncertain. HTLV-1-seropositive donors may improve transplantation results by providing viral-specific immunocompetent cells and preventing clonal expression of infected lymphocytes posttransplantation. However, there is a theoretical concern that recipients of stem cells from HTLV-1-seropositive donors, with oligoclonal integration in donor germline by Southern analysis,62 will be at risk of developing or relapsing with ATL after allogeneic stem cell transplantation.

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