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Adult T-cell leukemia/lymphoma (ATLL) incidence in US Caribbean-born populations approaches that of endemic regions. Early-life human T-cell leukemia virus type 1 (HTLV-1) infection is an actionable target for cancer prevention.

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Area of Science:

  • Oncology
  • Infectious Diseases
  • Epidemiology

Background:

  • Adult T-cell leukemia/lymphoma (ATLL) is an aggressive cancer caused by human T-cell leukemia virus type 1 (HTLV-1).
  • Mother-to-child transmission is a primary route for HTLV-1 infection, with screening and counseling reducing incidence in endemic regions like Japan.
  • In the US, HTLV-1 screening is limited, and mother-to-child transmission is not addressed, particularly in growing immigrant populations.

Purpose of the Study:

  • To estimate ATLL incidence in the US across different racial, ethnic, and birthplace groups.
  • To determine if ATLL incidence in specific US populations approaches levels seen in HTLV-1 endemic regions.
  • To assess survival rates for ATLL patients in the US.

Main Methods:

  • A population-based incidence and survival analysis was conducted using cancer registries from all 50 US states (2005-2022).
  • Individuals aged 15 years or older diagnosed with ATLL were included.
  • Analyses focused on race, ethnicity, and birthplace, with specific attention to non-Hispanic Caribbean-born US residents.

Main Results:

  • A total of 3228 ATLL cases were identified between 2005 and 2022.
  • Incidence was significantly higher among non-Hispanic Caribbean-born residents (14.1 per million) compared to US/Canada-born populations (0.4 per million).
  • Rates reached 33.7 per million in individuals born in Grenada; sensitivity analyses suggested higher rates approaching endemic levels. Five-year survival was poor at 23.8%, lowest in Caribbean-born individuals.

Conclusions:

  • ATLL incidence among non-Hispanic Caribbean-born US residents is comparable to historically endemic regions.
  • The findings highlight unaddressed early-life HTLV-1 exposure in the US due to lack of maternal screening.
  • Early-life infection is an actionable target for cancer prevention, potentially reducing future ATLL burden.