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Persistent HTLV\u20101 infection is established under the pressure of host immunity, and therefore the immune response against HTLV\u20101 is thought to reflect the status of the disease it causes. Indeed, it is known that cellular immunity against viral antigens is suppressed in ATL patients compared to HAM\/TSP patients. In this study, we show that profiling the humoral immunity to several HTLV\u20101 antigens, such as Gag, Env, and Tax, and measuring proviral load are useful tools for classifying disease status and predicting disease development. Using targeted sequencing, we found that several carriers whom this profiling method predicted to be at high risk for developing ATL indeed harbored driver mutations of ATL. The clonality of HTLV\u20101\u2010infected cells in those carriers was still polyclonal; it is consistent with an early stage of leukemogenesis. Furthermore, this study revealed significance of anti\u2010Gag proteins to predict high risk group in HTLV\u20101 carriers. Consistent with this finding, anti\u2010Gag cytotoxic T lymphocytes (CTLs) were increased in patients who received hematopoietic stem cell transplantation and achieved remission state, indicating the significance of anti\u2010Gag CTLs for disease control. Our findings suggest that our strategy that combines anti\u2010HTLV\u20101 antibodies and proviral load may be useful for prediction of the development of HTLV\u20101\u2010associated diseases.<\/jats:p>","DOI":"10.1111\/cas.15997","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T06:05:30Z","timestamp":1699682730000},"page":"310-320","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Anti\u2010HTLV\u20101 immunity combined with proviral load as predictive biomarkers for adult T\u2010cell leukemia\u2010lymphoma"],"prefix":"10.1111","volume":"115","author":[{"given":"Asami","family":"Yamada","sequence":"first","affiliation":[{"name":"Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Sciences, Faculty of Life Sciences Kumamoto University  Kumamoto 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