HTLV–1関連脊髄症

抄録

Human T–cell leukemia virus–1 (HTLV–1)–associated myelopathy (HAM) is chronic progressive myelopathy induced by chronic inflammation in the spinal cord, mainly the lower thoracic cord, caused under the status of high HTLV–1 proviral load in the peripheral blood. The main neurological symptoms, which is motor dysfunction of the lower extremities by spastic paraparesis with urinary disturbance, are progressive and lead to a deterioration in the quality of life (QOL) of patients once the myelopathy develops. Therefore, novel and safe therapeutic regimens are needed for HAM patients to be able to commence the treatments as soon as possible after the development. Although the ideal treatment against HAM is the elimination of HTLV–I–infected cells from the peripheral blood, various treatments were performed for HAM patients until now. Indeed, these treatments have produced some good results. However, there are still many of problems, such as insufficient effects, side effects. In addition, most of these treatments are the open trial in the short term, and it is unclear whether or not these treatments are available in the long–term treatment. Therefore, an ideal therapeutic strategy against HAM is still not established yet. We now need the therapeutic regimens to safely available in long–term course or lifelong course of treatment. Considering the treatment against HAM, its strategies are composed of three parts such as the treatment focusing to, 1) anti–viral effects, 2) anti–inflammatory effects by immunomodulation, and 3) symptomatic treatments for both spastic paraparesis and neurogenic bladder. In this review, we will discuss about the therapeutic strategies by the representative regimens against HAM up to now with introducing the recent reports about the efficacy of new regimens. In addition, we will introduce new regimens having the potential as the candidate of new therapeutic strategies.