Study Finds Screening Gap for HTLV-1 Linked Leukemia in US Caribbean-Born Communities

Researchers at Sylvester Comprehensive Cancer Center have highlighted a gap in screening for adult T‑cell leukemia/lymphoma (ATLL) that could be addressed by preventing mother‑to‑child transmission of HTLV‑1. The analysis focuses on U.S. populations where the virus is more prevalent, particularly among individuals born in the Caribbean.

Data show that non‑Hispanic Caribbean‑born residents have more than a 30‑fold higher incidence of ATLL compared with U.S. or Canada‑born groups, with Florida emerging as a hotspot due to its large Caribbean community. Since 2000, tens of thousands of births have occurred to mothers from HTLV‑1 endemic regions, approaching one million nationwide.

The study suggests that many ATLL cases are currently misclassified as peripheral T‑cell lymphoma not otherwise specified (PTCL‑NOS), which masks the true disease burden. Sensitivity analyses reallocating these misdiagnosed cases nearly double the estimated ATLL incidence among Caribbean‑born individuals.

The authors propose targeted prenatal HTLV‑1 screening based on maternal country of birth, combined with breastfeeding counseling, as a practical prevention strategy. This approach mirrors Japan’s successful nationwide program that led to a decline in ATLL cases.