Reviewer’ s report
Title: Clinical characteristics of adult T-cell leukemia/lymphoma infiltration in the gastrointestinal
tract
Version: 3Date: 24 Apr 2020
Reviewer: Kyosuke Tanaka
Reviewer's report:
Comments to Author: The submitted manuscript presents clinical characteristics of GI infiltration
of ATL. The manuscript has some concerns to be clarified.
Major concerns:1.Page 5, line 54. This medical journal is mainly for gastroenterologists including me, not for
hematologists, thus you should explain ATL subtypes in detail. That is not only reference, but alsoclinical meanings.2.In the line 29 of page 6, only 29 of all 40 patients underwent colonoscopy. Could you classify GIinfiltration or not? Furthermore, there are not information of small intestine by CT or endoscopyincluding capsule endoscopy and balloon assisted enteroscopy.3.In the line 32 of page, the authors should explain definition of GI findings in detail. Because GIinfiltration of ATL is not so common and every endoscopist is not familiar with this classification.4.In the line 38 of page 6, what do you mean that 5 patients had stable disease activity?5.In the line 13 of page 6, the authors described "instead." Probably, I guess this means "instead ofconventional endoscope." But it is hard to understand.
6.In the line 13 of page 7, the authors divided the patients into two groups. The definition of the
division should be clarified. Did you perform endoscopic random biopsies, abdominal CT andsmall intestinal endoscopy?7.In the conclusion, the authors wrote that physicians should perform GI endoscopy to investigateATLL infiltration in GI tract. But, according to the result of this study, GI endoscopy is notnecessary for ATLL patients with skin lesions.8.The authors should clarify the GI adverse event during chemotherapy or clinical course in theATLL patients especially the patients with GI infiltration. Because it is unclear if endoscopy isuseful for ATL patient.9.In the Table 2, the authors described that ten patients with positive endoscopic findings arenegative for ATL infiltration. What were the lesion with positive findings in ten patients, gastritisor insufficient biopsy specimens?
Minor concerns:
1.In the line 45 of page 6, IEE is abbreviation. Spell out abbreviations and acronyms the first timethe terms appear in the text.2.In Table 5, Clinical subtypes of ATLL means chronic or smoldering, the authors shouldreconsider the description and the calculation. Because the odds ratio is less than 1.0 and the
journal readers might not understand.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
Reviewer’ s report
Title: Clinical characteristics of adult T-cell leukemia/lymphoma infiltration in the gastrointestinal
tract
Version: 3Date: 24 Apr 2020
Reviewer: Kyosuke Tanaka
Reviewer's report:
Comments to Author: The submitted manuscript presents clinical characteristics of GI infiltration
of ATL. The manuscript has some concerns to be clarified.
Major concerns:1.Page 5, line 54. This medical journal is mainly for gastroenterologists including me, not for
hematologists, thus you should explain ATL subtypes in detail. That is not only reference, but alsoclinical meanings.2.In the line 29 of page 6, only 29 of all 40 patients underwent colonoscopy. Could you classify GIinfiltration or not? Furthermore, there are not information of small intestine by CT or endoscopyincluding capsule endoscopy and balloon assisted enteroscopy.3.In the line 32 of page, the authors should explain definition of GI findings in detail. Because GIinfiltration of ATL is not so common and every endoscopist is not familiar with this classification.4.In the line 38 of page 6, what do you mean that 5 patients had stable disease activity?5.In the line 13 of page 6, the authors described "instead." Probably, I guess this means "instead ofconventional endoscope." But it is hard to understand.
6.In the line 13 of page 7, the authors divided the patients into two groups. The definition of the
division should be clarified. Did you perform endoscopic random biopsies, abdominal CT andsmall intestinal endoscopy?7.In the conclusion, the authors wrote that physicians should perform GI endoscopy to investigateATLL infiltration in GI tract. But, according to the result of this study, GI endoscopy is notnecessary for ATLL patients with skin lesions.8.The authors should clarify the GI adverse event during chemotherapy or clinical course in theATLL patients especially the patients with GI infiltration. Because it is unclear if endoscopy isuseful for ATL patient.9.In the Table 2, the authors described that ten patients with positive endoscopic findings arenegative for ATL infiltration. What were the lesion with positive findings in ten patients, gastritisor insufficient biopsy specimens?
Minor concerns:
1.In the line 45 of page 6, IEE is abbreviation. Spell out abbreviations and acronyms the first timethe terms appear in the text.2.In Table 5, Clinical subtypes of ATLL means chronic or smoldering, the authors shouldreconsider the description and the calculation. Because the odds ratio is less than 1.0 and the
journal readers might not understand.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
Please review this paper.
user
Reviewer’ s report
Title: Clinical characteristics of adult T-cell leukemia/lymphoma infiltration in the gastrointestinal
tract
Version: 3Date: 24 Apr 2020
Reviewer: Kyosuke Tanaka
Reviewer's report:
Comments to Author: The submitted manuscript presents clinical characteristics of GI infiltration
of ATL. The manuscript has some concerns to be clarified.
Major concerns:1.Page 5, line 54. This medical journal is mainly for gastroenterologists including me, not for
hematologists, thus you should explain ATL subtypes in detail. That is not only reference, but alsoclinical meanings.2.In the line 29 of page 6, only 29 of all 40 patients underwent colonoscopy. Could you classify GIinfiltration or not? Furthermore, there are not information of small intestine by CT or endoscopyincluding capsule endoscopy and balloon assisted enteroscopy.3.In the line 32 of page, the authors should explain definition of GI findings in detail. Because GIinfiltration of ATL is not so common and every endoscopist is not familiar with this classification.4.In the line 38 of page 6, what do you mean that 5 patients had stable disease activity?5.In the line 13 of page 6, the authors described "instead." Probably, I guess this means "instead ofconventional endoscope." But it is hard to understand.
6.In the line 13 of page 7, the authors divided the patients into two groups. The definition of the
division should be clarified. Did you perform endoscopic random biopsies, abdominal CT andsmall intestinal endoscopy?7.In the conclusion, the authors wrote that physicians should perform GI endoscopy to investigateATLL infiltration in GI tract. But, according to the result of this study, GI endoscopy is notnecessary for ATLL patients with skin lesions.8.The authors should clarify the GI adverse event during chemotherapy or clinical course in theATLL patients especially the patients with GI infiltration. Because it is unclear if endoscopy isuseful for ATL patient.9.In the Table 2, the authors described that ten patients with positive endoscopic findings arenegative for ATL infiltration. What were the lesion with positive findings in ten patients, gastritisor insufficient biopsy specimens?
Minor concerns:
1.In the line 45 of page 6, IEE is abbreviation. Spell out abbreviations and acronyms the first timethe terms appear in the text.2.In Table 5, Clinical subtypes of ATLL means chronic or smoldering, the authors shouldreconsider the description and the calculation. Because the odds ratio is less than 1.0 and the
journal readers might not understand.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
NoDoes the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
No
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require furtherassessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose
financially from the publication of this manuscript, either now or in the future?
3. Do you hold or are you currently applying for any patents relating to the content of the
manuscript?
4. Have you received reimbursements, fees, funding, or salary from an organization that holds
or has applied for patents relating to the content of the manuscript?
5. Do you have any other financial competing interests?
6. Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.I agree to the open peer review policy of the journal. I understand that my name will be included
on my report to the authors and, if the manuscript is accepted for publication, my named report
including any attachments I upload will be posted on the website along with the authors'
responses. I agree for my report to be made available under an Open Access Creative CommonsCC-BY license (http://creativecommons.org/licenses/by/4.0/). I understand that any commentswhich I do not wish to be included in my named report can be included as confidential commentsto the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant