Lymphocyte expansion after unrelated cord blood allogeneic stem cell transplantation in adults

Persistent Large Granular Lymphocyte Clonal Expansions: “The Root of Many Evils”—And of Some Goodness

Simple Summary

Large granular lymphocyte leukemia (LGLL) is a chronic disorder of either mature T or NK lymphocytes. As clonal expansions of the immune system cells, difficulties in the distinction between a true neoplasia and a physiological reactive process have been common since its description. We review here the different conditions associated with persistent clonal LGL expansions and discuss their potential origin and whether they can modulate the clinical features.

Abstract

Large granular lymphocyte leukemia (LGLL) is a chronic disease of either mature phenotype cytotoxic CD3+ T lymphocytes or CD3- NK cells. LGLL diagnosis is hampered by the fact that reactive persistent clonal LGL expansions may fulfill the current criteria for LGLL diagnoses. In addition to the presence of characteristic clinical and hematological signs such as anemia or neutropenia, LGLL/LGL clonal expansions have been associated with an array of conditions/disorders. We review here the presence of these persistent clonal expansions in autoimmune, hematological disorders and solid neoplasms and after hematopoietic stem cell transplantation. These associations are a unique translational research framework to discern whether these persistently expanded LGL clones are causes or consequences of the concomitant clinical settings and, more importantly, when they should be targeted.

[Clinical features and risk factors analyses of patients with T cell large granular lymphocytosis following allo-HSCT]

目的

探讨异基因造血干细胞移植（allo-HSCT）后发生T大颗粒淋巴细胞增多（T-LGL）患者的临床特征、相关因素以及对预后的影响。

方法

回顾性分析2013年6月至2020年2月接受allo-HSCT的359例患者连续性资料，男216例，女143例，中位年龄为38（7~65）岁。分析T-LGL的临床特征、累积发生率，比较发生与未发生T-LGL患者的总生存（OS）率、无病生存（DFS）率、累积复发率（CIR）及非复发死亡率（NRM）的差异，并研究影响移植后发生T-LGL的相关因素。

结果

共入组359例患者，T-LGL组17例，非LGL组342例，中位随访38（3~92）个月，移植后1、2、3年T-LGL累积发生率分别为3.64%（95%CI 1.09%~6.19%）、4.50%（95%CI 1.36%~7.64%）和4.84%（95%CI 1.10%~8.76%）；移植受者CMV再激活（P=0.013）、EBV血症（P=0.034）以及急性移植物抗宿主病（P=0.027）均与T-LGL发生有关，且多因素分析显示，良性血液病[P=0.027，OR=3.36（95%CI 1.15~9.89）]、单倍型移植[P=0.030，OR=4.67（95%CI 1.16~18.75）]、无关供者移植[P=0.041，OR=5.49（95%CI 1.10~28.16）]为移植后发生T-LGL的独立预测因素。两组患者移植后3年OS、DFS率、CIR以及NRM差异均有统计学意义[OS：100.0%对78.6%（95%CI 74.1%~83.1%），P=0.04；DFS：100.0%对70.0%（95%CI 64.9%~75.1%），P=0.01；CIR：0对16.1%（95%CI 11.8%~22.4%），P<0.01；NRM：0对12.6%（95%CI 12.5%~12.6%），P=0.02]。亚组分析结果显示，恶性疾病患者移植后发生T-LGL者预后良好，NRM、DFS率以及CIR差异均有统计学意义（P值均<0.05），而良性疾病患者移植后发生T-LGL对预后无明显影响。

结论

恶性疾病患者移植后T-LGL可能是一个较为持久的良性临床过程，与免疫重建和T细胞调节机制相关的因素可作为移植后T-LGL发生的主要预测因素。