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However, direct assessment of HTLV\u20101 integration\u2010site clonality requires genetic analyses that are costly and labour\u2010intensive. We developed a simple flow cytometric surrogate assay by combining the HTLV\u20101 analysis system by flow cytometry (HAS\u2010Flow) method, which efficiently identifies HTLV\u20101\u2013infected cells, with T\u2010cell receptor \u03b2\u2010chain constant region (TRBC1\/2) staining. We analysed 53 HTLV\u20101\u2013infected individuals, including asymptomatic carriers (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200925), patients with HTLV\u20101\u2013associated myelopathy (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20094) and patients with ATL (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200924). TRBC1\/2 skewing was quantified using the dominant TRBC ratio. The dominant TRBC ratio was significantly higher in ATL than in non\u2010ATL cases and effectively discriminated ATL from non\u2010ATL cases (Area under the receiver operating characteristic curve [AUC], 0.913; 95% confidence interval, 0.803\u20131.000;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). It correlated with established markers of disease progression, including abnormal lymphocyte burden, proviral load and soluble interleukin\u20102 receptor levels, as well as clonality assessed by two independent HTLV\u20101 integration\u2010site\u2013based methods (viral integration site and RAISING\u2010CLOVA). These findings indicate that assessment of TRBC1\/2 skewing in HTLV\u20101\u2013infected cells (HAS\u2010TRBC method) is a simple, cost\u2010effective surrogate for estimating T\u2010cell clonality within HTLV\u20101\u2013infected cell populations, with potential clinical utility.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70889","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:21:33Z","timestamp":1792142493000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flow cytometric assessment of T\u2010cell receptor \u03b2\u2010chain constant region 1\/2 skewing as a surrogate marker for clonality in human T\u2010cell leukaemia virus type\u20101\u2013infected cells"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2031-7385","authenticated-orcid":false,"given":"Koji","family":"Jimbo","sequence":"first","affiliation":[{"name":"Division of Hematopoietic Disease Control, The Institute of Medical Science The University of Tokyo  Tokyo Japan"},{"name":"Department of Hematology\/Oncology, Research Hospital, The Institute of Medical Science The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7897-1814","authenticated-orcid":false,"given":"Aileen G.","family":"Rowan","sequence":"additional","affiliation":[{"name":"Section of Virology, Department of Infectious Disease Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9071-4709","authenticated-orcid":false,"given":"Momoko","family":"Usui","sequence":"additional","affiliation":[{"name":"Section of Virology, Department of Infectious Disease Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2781-3457","authenticated-orcid":false,"given":"Kako","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Laboratory of Viral Oncology and Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8142-4686","authenticated-orcid":false,"given":"Makoto","family":"Yamagishi","sequence":"additional","affiliation":[{"name":"Laboratory of Viral Oncology and Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0883-2920","authenticated-orcid":false,"given":"Junya","family":"Makiyama","sequence":"additional","affiliation":[{"name":"Department of Hematology Sasebo City General Hospital  Nagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8234-5090","authenticated-orcid":false,"given":"Lucy B. M.","family":"Cook","sequence":"additional","affiliation":[{"name":"National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, St Mary's Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7527-0345","authenticated-orcid":false,"given":"Yoshihisa","family":"Yamano","sequence":"additional","affiliation":[{"name":"Department of Rare Diseases Research, Institute of Medical Science St. Marianna University School of Medicine  Kawasaki Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1665-9606","authenticated-orcid":false,"given":"Kaoru","family":"Uchimaru","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Research Hospital, The Institute of Medical Science The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6526-0992","authenticated-orcid":false,"given":"Yasuhito","family":"Nannya","sequence":"additional","affiliation":[{"name":"Division of Hematopoietic Disease Control, The Institute of Medical Science The University of Tokyo  Tokyo Japan"},{"name":"Department of Hematology\/Oncology, Research Hospital, The Institute of Medical Science The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5118-7950","authenticated-orcid":false,"given":"Shigeo","family":"Fuji","sequence":"additional","affiliation":[{"name":"Department of Hematology Osaka International Cancer Institute  Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2012.00322","article-title":"Adult T\u2010cell leukemia: a review of epidemiological evidence","volume":"3","author":"Iwanaga M","year":"2012","journal-title":"Front Microbiol"},{"issue":"11","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"E517","DOI":"10.1016\/S1470-2045(14)70202-5","article-title":"Human T\u2010cell leukaemia virus type I and adult T\u2010cell leukaemia\u2010lymphoma","volume":"15","author":"Ishitsuka K","year":"2014","journal-title":"Lancet Oncol"},{"issue":"8","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1200\/JCO.18.00501","article-title":"Revised adult T\u2010cell leukemia\u2010lymphoma international consensus meeting report","volume":"37","author":"Cook LB","year":"2019","journal-title":"J Clin 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