Elevation of Serum KL-6 Glycoprotein or Surfactant Protein-D in Adult T-cell Leukemia with Distinct Pulmonary Complications

Elevation of Serum KL-6 Glycoprotein or Surfactant Protein-D in Adult T-cell Leukemia with Distinct Pulmonary Complications

AKEMI OSAKA,¹ KATSUNORI YANAGIHARA,¹ YASUAKI YAMADA,¹ HIROO HASEGAWA,¹ NAOKO INOKUCHI,¹ TOMAYOSHI HAYASHI,¹ MINORI KOMODA,² SHIGEKI NAKAMURA,³ MUNEO AOYAMA,⁴ TAKASHI SAWADA⁵ and SHIMERU KAMIHIRA¹

¹Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
²Department of Hematology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
³Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
⁴Tsukuba Research Laboratories, Eisai Co., Ltd., Tsukuba, Japan
⁵Clinical Research Center, Eisai Co., Ltd., Tokyo, Japan

Patients with hematological malignancies frequently suffer from lung diseases as a complication. However, it is difficult to discriminate leukemic invasion into the lung from infectious pulmonary complications. The serum level of Krebs von den Lungen-6 (KL-6), which is a mucin-like glycoprotein, is increased in more than 70% of patients with interstitial pneumonia. Surfactant protein-D (SP-D) is produced mainly in the lung by alveolar type II and bronchiolar epithelial cells and is a useful serum marker for interstitial pneumonia. We therefore measured the levels of KL-6 and SP-D in sera from 128 patients (76 males and 52 females, mean age: 59 years) with hematological malignancies, including adult T-cell leukemia (ATL). Overall, the increase in KL-6 or SP-D, above each cut-off value (500 U/ml for KL-6 and 110 ng/ml for SP-D), was detected in 11 patients (8.6%) or 10 patients (7.8%), respectively. In contrast, among 67 ATL patients, 15 patients had high serum levels of KL-6 and/or SP-D; both were elevated in 2 patients, only KL-6 was elevated in 6 patients and only SP-D was elevated in 7 patients. Thus, serum KL-6 and SP-D appear to be elevated in a mutually exclusive manner in ATL. Indeed, high serum levels of KL-6 were closely related to the stage of ATL, while the serum SP-D was elevated in ATL patients with pulmonary infection. In conclusion, the combined measurement of KL-6 and SP-D in ATL may become a useful means to discriminate leukemic pulmonary lesions from infectious pulmonary complications.

Keywords —— Krebs von den Lungen-6; surfactant protein-D; hematological malignancy; adult T-cell leukemia; interstitial pneumonia.

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Tohoku J. Exp. Med., 2009, 218, 99-105

Correspondence: Katsunori Yanagihara MD, PhD, Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki City, Nagasaki 852-8501, Japan.

e-mail: k-yanagi@ nagasaki-u.ac.jp