A Case of Adult T-Cell Leukemia Following Satralizumab Treatment for Neuromyelitis Optica Spectrum Disorder

Kenzo Sakurai; Yumi Ashikawa; Yoichiro Imaoka; Kumi Ohshima; Fumiaki Sano; Ayako Arai; Naoko Yagishita; Natsumi Araya; Makoto Nakashima; Erika Horibe; Tomoo Sato; Yoshihisa Yamano

doi:10.2169/internalmedicine.5938-25

Kenzo Sakurai, Yumi Ashikawa, Yoichiro Imaoka, Kumi Ohshima, Fumiaki Sano, Ayako Arai, Naoko Yagishita, Natsumi Araya, Makoto Nakashima, Erika Horibe, Tomoo Sato, Yoshihisa Yamano

Author information

Kenzo Sakurai
Department of Neurology, St. Marianna University School of Medicine, Japan
Yumi Ashikawa
Department of Neurology, St. Marianna University School of Medicine, Japan
Yoichiro Imaoka
Department of Neurology, St. Marianna University School of Medicine, Japan
Kumi Ohshima
Department of Hematology and Oncology, St. Marianna University Graduate School of Medicine, Japan
Fumiaki Sano
Department of Hematology and Oncology, St. Marianna University Graduate School of Medicine, Japan
Ayako Arai
Department of Hematology and Oncology, St. Marianna University Graduate School of Medicine, Japan
Naoko Yagishita
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan
Natsumi Araya
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan
Makoto Nakashima
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan
Erika Horibe
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan
Tomoo Sato
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan
Yoshihisa Yamano
Department of Neurology, St. Marianna University School of Medicine, Japan
Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Japan

Keywords: adult T-cell leukemia, HTLV-1, clonality, interleukin-6, neuromyelitis optica spectrum disorder, satralizumab

JOURNAL OPEN ACCESS Advance online publication

Article ID: 5938-25

DOI https://doi.org/10.2169/internalmedicine.5938-25

Details

Abstract

A 78-year-old woman with AQP4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) developed acute-type adult T-cell leukemia (ATL) 1 month after initiating satralizumab, without prior HTLV-1 screening. She presented with respiratory symptoms and hematochezia after receiving three doses. Laboratory tests revealed abnormal lymphocytosis and HTLV-1 positivity, with monoclonal proliferation. Despite CHOP chemotherapy, the patient died within two weeks of treatment initiation. IL-6 inhibition may impair the host defense against HTLV-1 oncogenesis. This case highlights the potential risk of ATL following treatment with satralizumab, especially in HTLV-1 endemic areas, and the importance of HTLV-1 screening and clonality assessment before treatment in patients with NMOSD.

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