Supportive Care

Patients with ATL often present with infectious complications (i.e., bacterial, fungal, protozoal, and/or viral) at diagnosis (Table 63.1).15 Infectious complications at diagnosis were observed less frequently in the lymphoma subtype than all other subtypes (P < 0.01), suggesting that this subset of patients may be less immunosuppressed.15 Several mechanisms have been reported to account for this immunodeficient state, including impaired cytotoxic function of HTLV-1-infected CD8+ lymphocytes, modulation of helper T-lymphocyte responses with predominantly a TH1 cytokine response, and suppressed production of T lymphocytes in the thymus in HTLV-1-infected individuals.120-122

Prevention of opportunistic infections is, therefore, crucial to improving survival in ATL. Prophylactic co-trimoxazole is effective in reducing the incidence of Pneumocystis carinii pneumonia in patients with ATL. Stool should be screened for Strongyloides at diagnosis, and patients with positive cultures treated. These patients may require prolonged prophylaxis against Strongyloides. Similarly, prophylaxis against fungal and viral infections should be considered.

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