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Marchand T, Pastoret C, Damaj G, Lebouvier A, Herbaux C, Moignet A, Pavlosky M, Pavlosky A, Blouet A, Eloit M, Launay V, Lebreton P, Stamatoullas A, Nilsson C, Ochmann M, Prola J, Lamy T. Efficacy of ruxolitinib in the treatment of relapsed/refractory large granular lymphocytic leukaemia. Br J Haematol 2024. [PMID: 38639192 DOI: 10.1111/bjh.19476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
Large granular lymphocytic (LGL) leukaemia is a rare chronic lymphoproliferative disorder characterized by an expansion of cytotoxic T or NK cells. Despite a usually indolent evolution, most patients will require a treatment over the course of the disease because of cytopenia or symptomatic associated autoimmune disorders. First-line treatment is based on immunosuppressive agents, namely cyclophosphamide, methotrexate and ciclosporin. However, relapses are frequent, and there is no consensus on the management of relapsed/refractory patients. The implication of the JAK/STAT pathway in the pathogenesis of this disease has prompted our group to propose treatment with ruxolitinib. A series of 21 patients who received this regimen is reported here. Ten patients (47.6%) were refractory to the three main immunosuppressive drugs at the time of ruxolitinib initiation. Ruxolitinib yielded an overall response rate of 86% (n = 18/21), including 3 complete responses and 15 partial responses. With a median follow-up of 9 months, the median response duration was 4 months. One-year event-free survival and 1-year overall survival were 57% and 83% respectively. Mild side effects were observed. Biological parameters, notably neutropenia and anaemia, improved significantly, and complete molecular responses were evidenced. This study supports ruxolitinib as a valid option for the treatment of relapsed/refractory LGL leukaemia.
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Affiliation(s)
- Tony Marchand
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Université de Rennes, Rennes, France
- UMR 1236, Rennes University, INSERM, Établissement Français du Sang Bretagne, Rennes, France
| | - Cédric Pastoret
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Gandhi Damaj
- Institut d'Hématologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Angélique Lebouvier
- Institut d'Hématologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Charles Herbaux
- Service d'Hématologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
- Institut de Génétique Humaine, UMR 9002 CNRS-UM, Montpellier, France
| | - Aline Moignet
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Miguel Pavlosky
- Fundaleu-Fundación Para Combatir la Leucemia, Buenos Aires, Argentina
| | - Astrid Pavlosky
- Fundaleu-Fundación Para Combatir la Leucemia, Buenos Aires, Argentina
| | - Anaise Blouet
- Hématologie, Strasbourg Oncologie Libérale, Clinique Saint Anne, Strasbourg, France
| | - Martin Eloit
- Service d'Hématologie et de Thérapie Cellulaire, Centre Hospitalier Universitaire de Tours, France
| | - Vincent Launay
- Service d'Hématologie, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | | | | | | | - Marlène Ochmann
- Service d'Hématologie, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Juliette Prola
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Thierry Lamy
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Université de Rennes, Rennes, France
- UMR 1236, Rennes University, INSERM, Établissement Français du Sang Bretagne, Rennes, France
- CIC 1414, Rennes, France
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Ullah F, Markouli M, Orland M, Ogbue O, Dima D, Omar N, Mustafa Ali MK. Large Granular Lymphocytic Leukemia: Clinical Features, Molecular Pathogenesis, Diagnosis and Treatment. Cancers (Basel) 2024; 16:1307. [PMID: 38610985 PMCID: PMC11011145 DOI: 10.3390/cancers16071307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Large granular lymphocytic (LGL) leukemia is a lymphoproliferative disorder characterized by persistent clonal expansion of mature T- or natural killer cells in the blood via chronic antigenic stimulation. LGL leukemia is associated with specific immunophenotypic and molecular features, particularly STAT3 and STAT5 mutations and activation of the JAK-STAT3, Fas/Fas-L and NF-κB signaling pathways. Disease-related deaths are mainly due to recurrent infections linked to severe neutropenia. The current treatment is based on immunosuppressive therapies, which frequently produce unsatisfactory long-term responses, and for this reason, personalized approaches and targeted therapies are needed. Here, we discuss molecular pathogenesis, clinical presentation, associated autoimmune disorders, and the available treatment options, including emerging therapies.
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Affiliation(s)
- Fauzia Ullah
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
| | - Mariam Markouli
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Mark Orland
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
| | - Olisaemeka Ogbue
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
| | - Danai Dima
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44915, USA
| | - Najiullah Omar
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
| | - Moaath K. Mustafa Ali
- Department of Translational Hematology and Oncology Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44915, USA; (M.O.); (O.O.); (D.D.); (N.O.); (M.K.M.A.)
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH 44915, USA
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Coker-Gurkan A, Can E, Sahin S, Obakan-Yerlikaya P, Arisan ED. Atiprimod triggered apoptotic cell death via acting on PERK/eIF2α/ATF4/CHOP and STAT3/NF-ΚB axis in MDA-MB-231 and MDA-MB-468 breast cancer cells. Mol Biol Rep 2021; 48:5233-5247. [PMID: 34244887 DOI: 10.1007/s11033-021-06528-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/27/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE The constitutive activation of STAT3 through receptor tyrosine kinases triggered breast cancer cell growth and invasion-metastasis. Atiprimod impacts anti-proliferative, anti-carcinogenic effects in hepatocellular carcinoma, lymphoma, multiple myeloma via hindering the biological activity of STAT3. Dose-dependent atiprimod evokes first autophagy as a survival mechanism and then apoptosis due to prolonged ER stress in pituitary adenoma cells. The therapeutic efficiency and mechanistic action of atiprimod in breast cancer cells have not been investigated yet. Thus, we aimed to modulate the pivotal role of ER stress in atiprimod-triggered apoptosis in MDA-MB-231 and MDA-MB-468 breast cancer cells. RESULTS Dose- and time-dependent atiprimod treatment inhibits cell viability and colony formation in MDA-MB-468 and MDA-MB-231 breast cancer cells. A moderate dose of atiprimod (2 μM) inhibited STAT3 phosphorylation at Tyr705 residue and also suppressed the total expression level of p65. In addition, nuclear localization of STAT1, 3, and NF-κB was prevented by atiprimod exposure in MDA-MB-231 and MDA-MB-468 cells. Atiprimod evokes PERK, BiP, ATF-4, CHOP upregulation, and PERK (Thr980), eIF2α (Ser51) phosphorylation's. However, atiprimod suppressed IRE1α-mediated Atg-3, 5, 7, 12 protein expressions and no alteration was observed on Beclin-1, p62 expression levels. PERK/eIF2α/ATF4/CHOP axis pivotal role in atiprimod-mediated G1/S arrest and apoptosis via Bak, Bax, Bim, and PUMA upregulation in MDA-MB-468 cells. Moreover, atiprimod renders MDA-MB-231 more vulnerable to type I programmed cell death by plasmid-mediated increased STAT3 expression. CONCLUSION Atiprimod induced prolonged ER stress-mediated apoptosis via both activating PERK/eIF2α/ATF4/CHOP axis and suppressing STAT3/NF-κB transcription factors nuclear migration in TBNC cells.
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Affiliation(s)
- Ajda Coker-Gurkan
- Department of Molecular Biology and Genetics, Faculty of Engineering and Natural Sciences, Biruni University, Topkapı Campus, 34010, Istanbul, Turkey.
| | - Esin Can
- Department of Molecular Biology and Genetics, Science and Letters Faculty, Istanbul Kultur University, Atakoy Campus, 34156, Istanbul, Turkey
| | - Semanur Sahin
- Department of Molecular Biology and Genetics, Science and Letters Faculty, Istanbul Kultur University, Atakoy Campus, 34156, Istanbul, Turkey
| | - Pınar Obakan-Yerlikaya
- Department of Biomedical Engineering, Faculty of Engineering and Natural Sciences, Biruni University, Topkapı Campus, 34010, Istanbul, Turkey
| | - Elif-Damla Arisan
- Institute of Biotechnology, Gebze Technical University, Gebze, Turkey
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Wang L, Zhou Y, Tang J, Zhan Q, Liao Y. [CD4(-)/CD8(-)/CD56(+)/TCRγδ(+) T-cell large granular lymphocyte leukemia presenting as aplastic anemia: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:525-527. [PMID: 31340629 PMCID: PMC7342393 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L Wang
- Department of Hematology, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - Y Zhou
- Department of Clinical Laboratory, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - J Tang
- Department of Clinical Laboratory, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - Q Zhan
- Clinical Molecular Medicine Testing Center, First Affiliated Hospital of Chongqing Medicial University, Chongqing 400016, China
| | - Y Liao
- Department of Hematology, Chongqing the Fourth Hospital, Chongqing 400014, China
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Ekemen S, Uzay A, Bassullu N, Dikicioglu-Cetin E, Matsuda K, Ince U, Coban C. Does it take three to tango? An unsuspected multimorbidity of CD8 + T cell lymphoproliferative disorder, malaria, and EBV infection. Malar J 2018; 17:349. [PMID: 30290813 PMCID: PMC6173833 DOI: 10.1186/s12936-018-2497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is known to cause acute and deadly complications. However, malaria can cause unforeseen pathologies due to its chronicity. It increases the risk of endemic Burkitt Lymphoma development by inducing DNA damage in germinal centre (GC) B cells, and leading higher frequency of Epstein-Barr virus (EBV)-infected cells in GCs. EBV is well known for its tropism for B cells. However, less is known about EBV's interaction with T cells and its association with T cell lymphoma. CASE PRESENTATION A 43-year-old Sudanese male admitted to hospital in Istanbul, Turkey, a non-endemic country, with hyperpigmented painful skin rashes on his whole body. A complete blood count and a peripheral blood smear during admission revealed large granular lymphocytes (LGLs) with abnormally higher CD8 T cell numbers. Additional skin biopsy and pathology results were compatible with CD8+ T cell lymphoproliferative disorder with skin involvement. Patient was treated and discharged. However, a pathologist noticed unusual structures in skin tissue samples. Careful evaluation of skin biopsy samples by polarized microscopy revealed birefringent crystalloid structures resembling malarial haemozoin mainly loaded in macrophages and giant histiocytes. After purification of DNA from the skin biopsy samples, nested PCR was performed for the detection of Plasmodium parasites and Plasmodium falciparum DNA was amplified. Because, the co-presence of EBV infection with malaria is a well-known aetiology of lymphoma, EBV-early RNA (EBER) transcripts were investigated in paraffin-embedded tissue samples and found to be positive in macrophage-like histiocytes. CONCLUSIONS This is a unique case of malaria and EBV infection in a T-LGL lymphoma patient who presented in a non-endemic country. This case emphasizes the clinical importance of EBV monitoring in T-LGL patients with skin involvement. Notably, Plasmodium infection should be examined in patients from malaria endemic regions by pathological and molecular investigations.
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Affiliation(s)
- Suheyla Ekemen
- Acibadem Pathology Laboratory, Istanbul, Turkey. .,Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan.
| | - Ant Uzay
- Department of Internal Medicine, Acibadem University Medical Faculty, Istanbul, Turkey
| | | | | | - Kyoko Matsuda
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan
| | - Umit Ince
- Acibadem Pathology Laboratory, Istanbul, Turkey.,Department of Pathology, Acibadem University Medical Faculty, Istanbul, Turkey
| | - Cevayir Coban
- Laboratory of Malaria Immunology, Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan
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Abstract
Large granular lymphocytes (LGLs) are large lymphocytes with azurophilic granules in their cytoplasm. LGLs are either natural killer (NK) cells or T lymphocytes. Expansions of the LGLs in the peripheral blood are seen in various conditions, including three clonal disorders: T-cell LGL (T-LGL) leukemia, chronic lymphoproliferative disorders of NK cells (CLPD-NK), and aggressive NK-cell leukemia (ANKL). However, the monoclonal and polyclonal expansion of LGLs has been associated with many other conditions. The present article describes these LGL disorders, with special emphasis on the clinical features, pathogenesis, and treatments of the three above-mentioned clonal disorders.
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Affiliation(s)
- Kazuo Oshimi
- Department of Medicine, Kushiro Rosai Hospital, Japan
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7
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Munir T, Bishton MJ, Carter I, McMillan A, O'Connor S, Sovani V, Haynes AP, Fox CP. Single-center Series of Bone Marrow Biopsy-Defined Large Granular Lymphocyte Leukemia: High Rates of Sustained Response to Oral Methotrexate. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:705-712. [PMID: 27640075 DOI: 10.1016/j.clml.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/07/2016] [Accepted: 08/02/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Large granular lymphocyte (LGL) leukemia is a rare chronic lymphoproliferative disorder, with few large series reported to date. Series using stringent diagnostic criteria incorporating bone marrow biopsy (BMB), immunophenotyping, and T-cell receptor rearrangements are even scarcer. PATIENTS AND METHODS The present study was a single-center series of 39 patients with LGL leukemia diagnosed using immunohistochemical analysis of BMB samples and flow cytometric and molecular data. RESULTS With a median follow-up of 3.2 years (range, 1.0-15.1 years), 15 patients (38%) never required treatment. Of the remaining 24 patients requiring treatment, 13 were initially treated with prednisolone, for an overall response rate (ORR) of 84.6% and a median duration of response (DOR) of 13.5 months (range, 5.7-70.3 months). Of the 24 patients, 9 received oral low-dose weekly methotrexate as first-line therapy, with 8 (89%) achieving a hematologic response and a median DOR of 132.7 months (range, 6.7-180.5 months). Another 5 patients received methotrexate after prednisolone failure; all 5 responded, with a median DOR of 14 months (range, 4-96 months). Only 2 patients developed progression during methotrexate therapy, and 4 patients experienced responses lasting ≥ 5 years. CONCLUSION Single-agent oral methotrexate appears to be highly efficacious, resulting in long response durations and minimal toxicity.
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Affiliation(s)
- Talha Munir
- Department of Clinical Hematology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom.
| | - Mark J Bishton
- Department of Clinical Hematology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Ian Carter
- Department of Molecular Diagnostics, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Andrew McMillan
- Department of Clinical Hematology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Simon O'Connor
- Department of Histopathology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Vishakha Sovani
- Department of Histopathology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Andrew P Haynes
- Department of Clinical Hematology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
| | - Christopher P Fox
- Department of Clinical Hematology, Nottingham University Hospitals National Health Services Trust, Nottingham, United Kingdom
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Peng G, Yang W, Zhang L, Zhou K, Li Y, Li Y, Ye L, Li J, Fan H, Song L, Zhao X, Wu Z, Zhang F, Jing L. Moderate-dose cyclophosphamide in the treatment of relapsed/refractory T-cell large granular lymphocytic leukemia-associated pure red cell aplasia. Hematology 2016; 21:138-43. [PMID: 27077768 DOI: 10.1080/10245332.2015.1101977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Guangxin Peng
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Wenrui Yang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Li Zhang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Kang Zhou
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Yang Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Yuan Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Lei Ye
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Jianping Li
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Huihui Fan
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Lin Song
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Xin Zhao
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Zhijie Wu
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Fengkui Zhang
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
| | - Liping Jing
- Department of Anemia Therapeutic Centre, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences (CAMS & PUMC), Tianjin, China
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Alemtuzumab in T-cell large granular lymphocyte leukaemia. LANCET HAEMATOLOGY 2016; 3:e4-5. [DOI: 10.1016/s2352-3026(15)00281-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
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10
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Dumitriu B, Ito S, Feng X, Stephens N, Yunce M, Kajigaya S, Melenhorst JJ, Rios O, Scheinberg P, Chinian F, Keyvanfar K, Battiwalla M, Wu CO, Maric I, Xi L, Raffeld M, Muranski P, Townsley DM, Young NS, Barrett AJ, Scheinberg P. Alemtuzumab in T-cell large granular lymphocytic leukaemia: interim results from a single-arm, open-label, phase 2 study. LANCET HAEMATOLOGY 2015; 3:e22-9. [PMID: 26765645 PMCID: PMC4721315 DOI: 10.1016/s2352-3026(15)00227-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 01/27/2023]
Abstract
Background T-cell large granular lymphocytic leukemia (T-LGL) is a lymphoproliferative disease presenting with immune-mediated cytopenias and characterized by clonal expansion of cytotoxic CD3+CD8+ lymphocytes. Methotrexate, cyclosporine, or cyclophosphamide improve cytopenias in 50% of patients as first therapy, but the activity of an anti-CD52 monoclonal antibody, alemtuzumab, is not defined in T-LGL. Methods Twenty-five consecutive subjects with T-LGL were enrolled from October 2006 to March 2015 at the National Institutes of Health (www.clinicaltrials.gov-NCT00345345). Alemtuzumab was administered at 10 mg/day intravenously for 10 days. The primary endpoint was haematologic response at 3 months. Analysis was intention to treat. Here we report the protocol specified interim benchmark of a phase II clinical trial using alemtuzumab in T-LGL. Findings In this heterogeneous, previously treated cohort, 14/25 (56%; 95% CI, 37–73%) subjects had a haematological response at 3 months. In T-LGL cases not associated with myelodysplasia or marrow transplantation, the response rate was 14/19 (74%; 95% CI, 51–86%). First dose infusion reactions were common which improved with symptomatic therapy. EBV and CMV reactivations were common and subclinical. In only 2 patients pre-emptive anti-CMV therapy was instituted. There were no cases of EBV or CMV disease. Alemtuzumab induced sustained reduction of absolute clonal population of T-cytotoxic lymphocytes, as identified by TCRBV-receptor phenotype, but the abnormal clone serendipitously persisted in responders. STAT3 mutations in the SH2 domain, identified in ten subjects, did not correlate with response. When compared with healthy volunteers, T-LGL subjects showed a distinct plasma cytokine and JAK-STAT signature prior to treatment, but neither correlated to response. Interpretation This is the largest and only prospective cohort of T-LGL subjects treated with alemtuzumab yet reported. The high activity with a single course of a lymphocytotoxic agent in a mainly relapsed and refractory suggests that haematologic response outcomes can be accomplished without the need for continued use of oral immunosuppression. Funding This research was supported by the Intramural Research Program of the NIH, National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Bogdan Dumitriu
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Sawa Ito
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Xingmin Feng
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Nicole Stephens
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Muharrem Yunce
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Sachiko Kajigaya
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Joseph J Melenhorst
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Olga Rios
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Priscila Scheinberg
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Fariba Chinian
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Keyvan Keyvanfar
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Irina Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes for Health, Bethesda, MD, USA
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes for Health, Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes for Health, Bethesda, MD, USA
| | - Pawel Muranski
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Danielle M Townsley
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Neal S Young
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Austin J Barrett
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes for Health, Bethesda, MD, USA
| | - Phillip Scheinberg
- Clinical Hematology, Antônio Ermírio de Moraes Cancer Center, Hospital São José and Beneficência Portuguesa, São Paulo, SP, Brazil.
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11
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[CD4⁺/CD8⁻ T- cell large granular lymphocytic leukemia: one case report and literatures reviews]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:739-42. [PMID: 26462772 PMCID: PMC7342710 DOI: 10.3760/cma.j.issn.0253-2727.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 提高对CD4+/CD8−T-大颗粒淋巴细胞白血病的认识。 方法 分析1例因皮疹、白细胞增多就诊的CD4+/CD8−T-大颗粒淋巴细胞白血病患者的临床资料,并复习相关文献。 结果 患者为老年女性,周身散在片状紫红色斑疹,外周血大颗粒淋巴细胞增多,呈CD3+/CD4+/CD8−免疫表型,PCR检测TCRγ、β基因重排阳性,流式细胞术检测TCRVβ2亚家族98%。 结论 CD3+/CD4+/CD8−变异型T-大颗粒淋巴细胞白血病少见,临床表现与经典T-大颗粒淋巴细胞白血病有所不同,应谨慎鉴别。
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LeBlanc FR, Loughran TP. Large granular lymphocyte leukemia: clinical background, molecular pathogenesis and treatment. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1062362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tees MT, Whitehurst MT, Sokol L. Treating rare lymphoproliferative malignancies: a focus on indolent large granular lymphocytic leukemia. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Large granular lymphocyte leukemia is a heterogeneous group of lymphoproliferative disorders that arises from mature T cells or NK cells. These disorders are relatively uncommon and usually present with cytopenias and/or autoimmune disorders. As patients often do not have symptoms warranting therapy upfront, surveillance is often employed. Common frontline therapies include cyclosphosphamide, methotrexate or cyclosporine A, however, no controlled trials or retrospective analyses have demonstrated one superior therapeutic strategy. Mechanisms of pathogenesis and survival have been identified that include abnormalities in the cell surface receptors halting apoptotic signals, dysregulation of prosurvival and apoptotic signaling pathways, and somatic mutations of the STAT3 and STAT5b genes, among others. Investigating novel therapies that target pathways shared by other neoplastic processes, as well as the identification of new agents directed toward the aberrant cellular mechanisms of large granular lymphocyte leukemia, are fundamental to moving from empiric chemotherapy to targeted therapies in the future.
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Affiliation(s)
- Michael T Tees
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Matthew T Whitehurst
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, H Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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Rashid A, Khurshid M, Ahmed A. T-cell large granular lymphocytic leukemia: 4 cases. Blood Res 2014; 49:203-5. [PMID: 25325044 PMCID: PMC4188790 DOI: 10.5045/br.2014.49.3.203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anila Rashid
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Khurshid
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
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Steinway SN, LeBlanc F, Loughran TP. The pathogenesis and treatment of large granular lymphocyte leukemia. Blood Rev 2014; 28:87-94. [PMID: 24679833 DOI: 10.1016/j.blre.2014.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Abstract
Large granular lymphocyte (LGL) leukemia is a spectrum of rare lymphoproliferative diseases of T lymphocytes and natural killer cells. These diseases frequently present with splenomegaly, neutropenia, and autoimmune diseases like rheumatoid arthritis. LGL leukemia is more commonly of a chronic, indolent nature; however, rarely, they have an aggressive course. LGL leukemia is thought to arise from chronic antigen stimulation, which drives long-term cell survival through the activation of survival signaling pathways and suppression of pro-apoptotic signals. These include Jak-Stat, Mapk, Pi3k-Akt, sphingolipid, and IL-15/Pdgf signaling. Treatment traditionally includes immunosuppression with low dose methotrexate, cyclophosphamide, and other immunosuppressive agents; however, prospective and retrospective studies reveal very limited success. New studies surrounding Jak-Stat signaling suggest this may reveal new avenues for LGL leukemia therapeutics.
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Affiliation(s)
| | - Francis LeBlanc
- Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.
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Zhao X, Zhou K, Jing L, Zhang L, Peng G, Li Y, Ye L, Li J, Fan H, Li Y, Zhang F. Treatment of T-cell large granular lymphocyte leukemia with cyclosporine A: experience in a Chinese single institution. Leuk Res 2013; 37:547-51. [PMID: 23395383 DOI: 10.1016/j.leukres.2013.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/17/2013] [Accepted: 01/21/2013] [Indexed: 11/24/2022]
Abstract
T-cell large granular lymphocyte leukemia (T-LGLL) is a rare chronic lymphoproliferative disorder. Available reported data on the treatment regimens of this disease are variable and limited due to low number of patients. We analyzed the efficiency of cyclosporine A (CsA) in the treatment of 28 patients with T-LGLL. The overall response rate (ORR) was 82.1% with hematologic complete remission (HCR) rate of 57.1%. The median time to response (TTR) was 1.8 months and treatment duration with CsA-based regimens was 34.5 months. CsA shows low and manageable toxicity during treatment. Twenty-one patients survived with a median follow-up time of 42.0 months. Our results indicate that CsA is efficacious and safe in the treatment of T-LGLL.
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Affiliation(s)
- Xin Zhao
- Department of Anemia Therapeutic Center, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Tianjin, PR China
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17
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Bockorny B, Dasanu CA. Autoimmune manifestations in large granular lymphocyte leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:400-5. [PMID: 22999943 DOI: 10.1016/j.clml.2012.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/17/2012] [Accepted: 06/15/2012] [Indexed: 12/16/2022]
Abstract
Large granular lymphocyte (LGL) leukemia features a group of indolent lymphoproliferative diseases that display a strong association with various autoimmune conditions. Notwithstanding, these autoimmune conditions have not been comprehensively characterized or systematized to date. As a result, their clinical implications remain largely unknown. The authors offer a comprehensive review of the existing literature on various autoimmune conditions documented in the course of T-cell LGL (T-LGL) leukemia. Though some of them are thought be secondary to the LGL leukemia, others could be primary and might even play a role in its pathogenesis. A considerable clinico-laboratory overlap between T-LGL leukemia associated with rheumatoid arthritis and Felty's syndrome suggests that they are just different eponyms for the same clinical entity.
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Affiliation(s)
- Bruno Bockorny
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT 06030-1235, USA.
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Costa RO, Bellesso M, Chamone DAF, Ruiz MA, Hallack Neto AE, Aldred VL, Pereira J. T-cell large granular lymphocytic leukemia: treatment experience with fludarabine. Clinics (Sao Paulo) 2012; 67:745-8. [PMID: 22892917 PMCID: PMC3400163 DOI: 10.6061/clinics/2012(07)07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 03/18/2012] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m², for three to five days per month and 6 to 8 cycles. RESULTS Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4 x 10(9)/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment due to liver toxicity, and one (16.6%) due to dyspepsia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.
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Affiliation(s)
- Renata Oliveira Costa
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo Hematology Department, São Paulo/SP, Brazil
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Pontikoglou C, Kalpadakis C, Papadaki HA. Pathophysiologic mechanisms and management of neutropenia associated with large granular lymphocytic leukemia. Expert Rev Hematol 2011; 4:317-28. [PMID: 21668396 DOI: 10.1586/ehm.11.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large granular lymphocyte (LGL) syndrome includes a spectrum of clonal T cell and natural killer cell chronic lymphoproliferative disorders. These conditions are thought to arise from chronic antigenic stimulation, while the long-term survival of the abnormal LGLs appears to be sustained by resistance to apoptosis and/or impaired survival signaling. T-cell LGL (T-LGL) leukemia is the most common LGL disorder in the Western world. Despite its indolent course, the disease is often associated with neutropenia, the pathogenesis of which is multifactorial, comprising both humoral and cytotoxic mechanisms. This article addresses the pathogenesis of T-LGL leukemia and natural killer cell chronic lymphoproliferative disorder, as well as that of T-LGL leukemia-associated neutropenia. Furthermore, as symptomatic neutropenia represents an indication for initiating treatment, available therapeutic options are also discussed.
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Mohan SR, Clemente MJ, Afable M, Cazzolli HN, Bejanyan N, Wlodarski MW, Lichtin AE, Maciejewski JP. Therapeutic implications of variable expression of CD52 on clonal cytotoxic T cells in CD8+ large granular lymphocyte leukemia. Haematologica 2011; 94:1407-14. [PMID: 19794084 DOI: 10.3324/haematol.2009.009191] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND T-cell large granular lymphocytic leukemia is a clonal proliferation of cytotoxic T-lymphocytes which often results in severe cytopenia. Current treatment options favor chronic immunosuppression. Alemtuzumab, a humanized monoclonal antibody against glycophosphatidylinositol-anchored CD52, is approved for patients refractory to therapy in other lymphoid malignancies. DESIGN AND METHODS We retrospectively examined treatment outcomes in 59 patients with CD8+ T-cell large granular lymphocytic leukemia, 41 of whom required therapy. Eight patients with severe refractory cytopenia despite multiple treatment regimens had been treated with subcutaneous alemtuzumab as salvage therapy. Flow cytometry was used to monitor expression of glycophosphatidylinositol-anchored CD52, CD55, and CD59 as well as to characterize T-cell clonal expansions by T-cell receptor variable beta-chain (Vbeta) repertoire. RESULTS Analysis of the effects of alemtuzumab revealed remissions with restoration of platelets in one of one patient, red blood cell transfusion independence in three of five patients and improvement of neutropenia in one of three, resulting in an overall response rate of 50% (4/8 patients). Clonal large granular lymphocytes exhibited decreased CD52 expression post-therapy in patients refractory to treatment. Samples of large granular lymphocytes collected prior to therapy also unexpectedly had a significant proportion of CD52-negative cells while a healthy control population had no such CD52 deficiency (p=0.026). CONCLUSIONS While alemtuzumab may be highly effective in large granular lymphocytic leukemia, prospective serial monitoring for the presence of CD52-deficient clonal cytotoxic T-lymphocytes should be a component of clinical trials investigating the efficacy of this drug. CD52 deficiency may explain lack of response to alemtuzumab, and such therapy may confer a survival advantage to glycophosphatidylinositol-negative clonal cytotoxic T-lymphocytes.
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Affiliation(s)
- Sanjay R Mohan
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Abstract
Large granular lymphocyte (LGL) leukemia is characterized by a clonal expansion of either CD3(+) cytotoxic T or CD3(-) NK cells. Prominent clinical features of T-LGL leukemia include neutropenia, anemia and rheumatoid arthritis (RA). The terminal effector memory phenotype (CD3(+)/CD45RA(+)/CD62L(-)CD57(+)) of T-LGL suggests a pivotal chronic antigen-driven immune response. LGL survival is then promoted by platelet-derived growth factor and interleukin-15, resulting in global dysregulation of apoptosis and resistance to normal pathways of activation-induced cell death. These pathogenic features explain why treatment of T-LGL leukemia is based on immunosuppressive therapy. The majority of these patients eventually need treatment because of severe or symptomatic neutropenia, anemia, or RA. No standard therapy has been established because of the absence of large prospective trials. The authors use low-dose methotrexate initially for T-LGL leukemia patients with neutropenia and/or RA. We recommend either methotrexate or oral cyclophosphamide as initial therapy for anemia. If treatment is not successful, patients are switched to either the other agent or cyclosporine. The majority of patients experience an indolent clinical course. Deaths infrequently occur because of infections related to severe neutropenia. As there are no curative therapeutic modalities for T-LGL leukemia, new treatment options are needed.
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22
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Pawarode A, Wallace PK, Ford LA, Barcos M, Baer MR. Long-term safety and efficacy of cyclosporin A therapy for T-cell large granular lymphocyte leukemia. Leuk Lymphoma 2010; 51:338-41. [PMID: 20038217 DOI: 10.3109/10428190903470851] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica 2010; 95:1534-41. [PMID: 20378561 DOI: 10.3324/haematol.2009.018481] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Large granular lymphocyte leukemia is a rare lymphoproliferative disorder associated with autoimmune diseases and impaired hematopoiesis. This study describes the clinical and biological characteristics of 229 patients with T-cell or NK-cell large granular lymphocyte leukemia. DESIGN AND METHODS The diagnosis was based on a large granular lymphocyte expansion (> 0.5x10(9)/L) lasting more than 6 months. Monoclonal T-cell receptor gamma gene rearrangement was detected in all the cases of T-cell large granular lymphocyte leukemia. Patients with chronic NK-cell lymphocytosis had an indolent disease, while those with multiorgan large granular lymphocyte infiltration and an aggressive clinical disease were considered to have NK-cell large granular lymphocyte leukemia. RESULTS The diagnosis of T-cell large granular lymphocyte leukemia was confirmed in 201 cases, chronic NK-cell lymphocytosis in 27 cases and NK-cell large granular lymphocyte leukemia in one case. Associated autoimmune diseases or other neoplasms were present in 74 and 32 cases, respectively. One hundred patients (44%) required treatment, mainly for neutropenia-associated infections (n=45), symptomatic autoimmune diseases (n =24), transfusion-dependant anemia (n=18), and other causes (n=13). Patients were treated with steroids (n= 33), methotrexate (n=62), cytoxan (n=32), or cyclosporine (n=24) either as first-, second-, third- or fourth-line therapy. The overall response rate at 3 months and complete response rate for the various treatments were as follows: steroids (12% and 3%), methotrexate (55% and 21%), cytoxan (66% and 47%), cyclosporine (21% and 4%), respectively. Four out of 13 patients responded to splenectomy. Eleven out of 15 patients responded to cytoxan after methotrexate treatment had failed. The mean number of treatments was 3.4 (range, 1-7). There were 15 large granular lymphocyte leukemia-related deaths. CONCLUSIONS Patients with T-cell large granular lymphocyte leukemia and chronic NK-cell lymphocytosis have similar clinical and biological features and responses to treatment. First-line therapy with cytoxan should be tested in a prospective trial.
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Affiliation(s)
- Benoît Bareau
- Service d'Hématologie Clinique, Hôpital Pontchaillou, CHU de Rennes 35033, France
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Fortune AF, Kelly K, Sargent J, O'brien D, Quinn F, Chadwick N, Flynn C, Conneally E, Browne P, Crotty GM, Thornton P, Vandenberghe E. Large granular lymphocyte leukemia: natural history and response to treatment. Leuk Lymphoma 2010; 51:839-45. [DOI: 10.3109/10428191003706947] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Olteanu H, Harrington AM, Ramirez S, Kroft SH, Hari P. Efficacy and safety of long-term (>7 year) alemtuzumab therapy for refractory T-cell large granular lymphocytic leukaemia. Br J Haematol 2010; 150:480-1. [DOI: 10.1111/j.1365-2141.2010.08218.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kwong YL, Au WY, Leung AYH, Tse EWC. T-cell large granular lymphocyte leukemia: an Asian perspective. Ann Hematol 2010; 89:331-9. [PMID: 20084380 PMCID: PMC7102052 DOI: 10.1007/s00277-009-0895-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 12/22/2009] [Indexed: 11/24/2022]
Abstract
To characterize T-cell large granular leukemia in Asia, 22 Chinese patients from a single institute were reported, together with an analysis of 88 Asian and 272 Western patients identified from the literature. In our cohort, anemia due to pure red cell aplasia (PRCA) occurred in 15/22 (68%) of cases, being the most common indication for treatment. Neutropenia was only found in 8/22 (36%) cases, and recurrent infections, the most important clinical problem in Western patients, were not observed. None of our cases presented with rheumatoid arthritis. These clinical features were consistently observed when compared with the 88 other Asian patients. Combined data from our cohort and other Asian cases showed that Asian patients, compared with Western patients, had more frequent anemia (66/110, 60% versus 113/240, 47%; p=0.044), attributable to a much higher incidence of PRCA (52/110, 47% versus 6/143, 4%; p<0.001). However, Western patients presented more frequently than Asian patients with neutropenia (146/235, 62% versus 33/110, 30%; p<0.001) and splenomegaly (99/246, 40% versus 16/110, 15%; p< 0.001). Notably, Western patients were about eight to ten times more likely than Asian patients to have rheumatoid arthritis (73/272, 27% versus 4/106, 4%; p<0.001) and recurrent infections (81/272, 30% versus 3/107, 3%; p<0.001). These clinicopathologic differences have important implications on disease pathogenesis and treatment.
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Affiliation(s)
- Yok-Lam Kwong
- Department of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.
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Sretenovic A, Antic D, Jankovic S, Gotic M, Perunicic-Jovanovic M, Jakovic L, Mihaljevic B. T-cell large granular lymphocytic (T-LGL) leukemia: a single institution experience. Med Oncol 2009; 27:286-90. [PMID: 19306076 DOI: 10.1007/s12032-009-9206-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 03/11/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND T-cell large granular lymphocytic (T-LGL) leukemia is a rare lymphoproliferative disease which usually affects elderly people. The clinical course of T-LGL leukemia is generally indolent, with lymphocytosis and splenomegaly in 20-50% patients, hepatomegaly in 5-20% of patients, and less commonly, lymphadenopathy. T-LGL leukemia is associated with immunological abnormalities: rheumatoid factor with or without rheumatoid arthritis (RA), Coombs positive hemolytic anemia, idiopathic thrombocytopenic purpura (ITP), pure red cell aplasia (PRCA), positive anti-nuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), hypogammaglobulinemia, and polyclonal hypergammaglobulinemia. Aim To compare clinical and laboratory features of T-LGL leukemia patients and their responses to different chemotherapy regimens. METHODS Six patients (3 males and 3 females) with T-LGL leukemia were analyzed. The diagnosis was based on accepted morphologic criteria, immunophenotype, and polymerase chain reaction (PCR) detection of T-cell receptor (TCR) gene rearrangements. RESULTS All patients exhibited lymphocytosis, mainly with unusual morphologies, splenomegaly, and elevated serum lactate dehydrogenase (LDH). Three patients were treated with a Fludarabine-Cyclophosphamide (FC) combination as initial therapy while three patients received CHOP. Two patients received more than one treatment regimen. One patient died due to T-LGL leukemia in first year after diagnosis, one patient died 4 years after diagnosis, two patients interrupted their treatment, and two patients are still alive. CONCLUSIONS Further prospective studies are needed for establishing a gold standard therapy for T-LGL leukemia.
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Affiliation(s)
- Aleksandra Sretenovic
- Institute of Hematology, Clinical Center Serbia, Koste Todorovica 2 Street, 11 000 Belgrade, Serbia
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Huh YO, Medeiros LJ, Ravandi F, Konoplev S, Jorgensen JL, Miranda RN. T-cell large granular lymphocyte leukemia associated with myelodysplastic syndrome: a clinicopathologic study of nine cases. Am J Clin Pathol 2009; 131:347-56. [PMID: 19228641 DOI: 10.1309/ajcp6yhi1jexawap] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We describe 9 patients with T-cell large granular lymphocyte leukemia (T-LGL) who also had a myelodysplastic syndrome (MDS). There were 6 men and 3 women with a median age of 60 years (range, 25-74 years). All patients had anemia at initial examination, 7 had neutropenia, and 5 had thrombocytopenia. The median absolute lymphocyte count was 1,300/microL (1.3 x 10(9)/L; range, 700-3,600/microL [0.7-3.6 x 10(9)/L]). Immunophenotypic analysis showed a CD8+ T-cell population, and molecular analysis showed monoclonal T-cell receptor gene rearrangement in every case. The MDS was classified as refractory cytopenia with multilineage dysplasia (RCMD, n = 5), refractory anemia (n = 2), RCMD with ringed sideroblasts (n = 1), and chronic myelomonocytic leukemia (n = 1). We compared the data for these patients with T-LGL/MDS with a group that had only T-LGL. The median hemoglobin level and absolute lymphocyte count were lower in patients with T-LGL/MDS (P < .05). The frequency of coexistent T-LGL and MDS at our institution suggests an etiologic relationship rather than simple coincidence.
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Affiliation(s)
- Yang O Huh
- Department of Hematopathology, Unit 72, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Kawahara S, Sasaki M, Isobe Y, Ando J, Noguchi M, Koike M, Hirano T, Oshimi K, Sugimoto K. Clinical analysis of 52 patients with granular lymphocyte proliferative disorder (GLPD) showed frequent anemia in indolent T-cell GLPD in Japan. Eur J Haematol 2009; 82:308-14. [PMID: 19220421 DOI: 10.1111/j.1600-0609.2009.01213.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present here clinical and hematological findings of 52 cases of granular lymphocyte-proliferative disorder (GLPD), which contained 35 indolent T-cell lineage granular lymphocyte-proliferative disorder (T-GLPD), two atypical T-GLPD, 12 chronic NK-cell lymphocytosis (CNKL), and three aggressive NK-cell leukemia (ANKL). The median period of follow up was 24 months. Hemoglobin level <8.0 g/dL was recognized in 21 cases of indolent T-GLPD (60%), among which 15 patients met the criteria of pure red cell aplasia. Neutrophil counts <500/microL occurred only in two cases of T-GLPD (6%). Although the median age and male-to-female distribution were similar, very frequent anemia and rare neutrocytopenia in indolent T-GLPD in the present study keenly contrasted with previous reports. CD56 was positive in three of 29 indolent T-GLPD cases with CD4-CD8+ phenotype, in three of four CD4+CD8-, and in none of two CD4-CD8- cases. Therefore, although two atypical T-GLPD cases were CD56-positive, CD56 should not be a specific marker for aggressive T-GLPD. All CNKL patients had a chronic course with a stable granular lymphocyte count. All three ANKL patients presented high fever and hepatosplenomegaly, barely responded to chemotherapies and died within 6 months. The present analysis of 52 cases of GLPD in Japan showed that Japanese and Western cases of indolent T-GLPD clearly differ in their hematological complications.
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Affiliation(s)
- Shimpei Kawahara
- Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
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Allegra A, Alessandro A, Alonci A, Bellomo G, Quartarone E, D'Angelo A, Rizzotti P, Granata A, Caterina M. Fludarabine based treatment caused improvement of anemia in a patient with T-cell LGL leukemia despite evidence of the persistence of the abnormal T-cell clone. Leuk Lymphoma 2008; 49:2006-8. [PMID: 18661392 DOI: 10.1080/10428190802272692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tse E, Chan JCW, Pang A, Au WY, Leung AYH, Lam CCK, Kwong YL. Fludarabine, mitoxantrone and dexamethasone as first-line treatment for T-cell large granular lymphocyte leukemia. Leukemia 2007; 21:2225-6. [PMID: 17525720 DOI: 10.1038/sj.leu.2404767] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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