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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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Seibert T, Loehrer PJ, O’Brien AR. Thymoma With Triple Threat: Pure Red Cell Aplasia, Autoimmune Hemolytic Anemia, and T-Cell Large Granular Lymphocytic Leukemia. J Hematol 2022; 11:223-232. [PMID: 36632575 PMCID: PMC9822658 DOI: 10.14740/jh1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023] Open
Abstract
Thymomas are a rare neoplasm of the anterior mediastinum and often associated with paraneoplastic syndromes. Though myasthenia gravis is the most common and well-known, the list of reported paraneoplastic syndromes occurring with thymoma is extensive and ever-growing. Paraneoplastic syndromes can involve nearly every organ system, including hematologic abnormalities affecting any or all cell lines. This can present challenges to the clinician in terms of diagnosis, prognostic impact, and management. We present the case of a previously healthy 41-year-old female who was diagnosed with thymoma and three rare hematologic paraneoplastic syndromes: pure red cell aplasia (PRCA), autoimmune hemolytic anemia (AIHA), and T-cell large granular lymphocytic leukemia (T-LGLL). To the best of our knowledge, there have been only four other reported cases of PRCA and AIHA in a single patient with thymoma, all of which were treated with thymectomy. Upfront surgical resection was not possible in the present case and thus the patient was alternatively treated with corticosteroids and octreotide, which proved successful in resolving the anemia. The authors present this case to share these findings of an alternative treatment strategy for thymoma-associated PRCA and AIHA and to highlight the importance of careful monitoring with routine blood work for these complex patients.
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Affiliation(s)
- Tara Seibert
- Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Patrick J. Loehrer
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrew R.W. O’Brien
- Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA,Corresponding Author: Andrew R.W. O’Brien, Division of Hematology/Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Bleesing J. Gain-of-function defects in toll-like receptor 8 shed light on the interface between immune system and bone marrow failure disorders. Front Immunol 2022; 13:935321. [PMID: 36119097 PMCID: PMC9479092 DOI: 10.3389/fimmu.2022.935321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
In this article, we will share lessons that patients with gain-of-function defects in Toll-like receptor 8 (TLR8-GOF) can teach us about the interface between bone marrow failure (BMF) disorders and inborn errors of immunity (IEI), subsequently referred to as “Interface Disorders”. TLR8-GOF is a relatively young entity (from a discovery standpoint) that—through both similar and dissimilar disease characteristics—can increase our understanding of interface disorders, for example, as it pertains to pathophysiology, the genetic mechanism of disease, and related diagnostics and therapeutics. From a genetics point of view, TLR8-GOF joins a growing list of (interface) disorders that can cause disease both with germline and somatic (mosaic) genetic variants. This not only has repercussions for the diagnostic workup of these disorders, inasmuch that routine genetic testing may miss somatic variants, but has therapeutic implications as well, for example, with the approach to curative treatment, such as hematopoietic stem cell transplantation. Following an introduction and schematic rendering of the interface, we will review the salient features of TLR8-GOF, with the understanding that the phenotype of this new disorder is likely not written in stone yet. In keeping with the principle of “Form Follows Function”, we will discuss specific immunological biomarkers that can be measured in clinical laboratories and highlight key disease features that pertain to TLR8-GOF, and can be found in several interface disorders. As can be seen from a schematic representation, the interface provides not only opportunities for learning and collaboration with respect to shared diagnostics but also the potential for drug repurposing and precision therapeutics. Ideally, collaboration also focuses on education and teaching, such that cross-fertilization and collaboration across these disciplines can create a framework for complementary research.
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Affiliation(s)
- Jack Bleesing
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- *Correspondence: Jack Bleesing,
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Braunstein Z, McLaughlin E, Ruiz M, Wei L, Bumma N, Benson D, Devarakonda S, Chaudhry M, Khan A, Cottini F, Hanel W, Baiocchi R, Chung C, Addison D, Couette N, Meara A, Jarjour W, Porcu P, Mishra A, Reneau JC, Rosko AE, Brammer JE. Incidence, Treatment, and Survival of Patients With T-Cell Lymphoma, T-Cell Large Granular Leukemia, and Concomitant Plasma Cell Dyscrasias. Front Oncol 2022; 12:858426. [PMID: 35574379 PMCID: PMC9106372 DOI: 10.3389/fonc.2022.858426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
T-Cell malignancies are a group of heterogeneous disorders composed of primary cutaneous T-cell lymphomas (CTCLs), peripheral T-cell lymphomas (PTCLs), and T-cell leukemias, including T-cell large granular lymphocytic leukemia (T-LGLL). Cases of patients with combined T-cell malignancies and plasma cell dyscrasias (PCD) are reported in the literature, but these are mostly limited to case reports or small case series with <10 patients. Here, we described the clinical course of 26 patients and report baseline characteristics and clinical outcomes including overall survival (OS), progression-free survival (PFS), and objective response rates (ORRs) in this unique population. There was no survival difference in patients with CTCL or T-LGLL and concomitant PCD when treated with standard therapy directed at the T-cell malignancy when compared to historical controls. However, patients with PTCL and concomitant PCD had significantly inferior outcomes with rapid progression and worse OS and PFS at 1.7 years (p=0.006) and 4.8 months (p=0.08), respectively, when compared to historical controls for patients with PTCL, although the limited number of patients included in this analysis precludes drawing definitive conclusions. Treatment directed at the T-cell malignancy resulted in the eradication of the PCD clone in multiple patients (15.4%) including one with multiple myeloma (MM) who experienced a complete response after starting therapy directed at the T-cell malignancy. For patients with T-cell malignancies and concomitant PCD, treatment with standard T-cell-directed therapies is recommended based on this analysis with continued follow-up and monitoring of the concomitant PCD. Further studies are needed to definitively elucidate the increased risk of relapse in patients with PTCL and concomitant PCD, and larger, multi-center cohorts are needed to validate these findings across T-cell malignancies and PCDs.
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Affiliation(s)
- Zachary Braunstein
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Eric McLaughlin
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Miguel Ruiz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Lai Wei
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Naresh Bumma
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Don Benson
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Srinivas Devarakonda
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Maria Chaudhry
- Division of Hematology, George Washington Cancer Center, George Washington University, Washington, DC, United States
| | - Abdullah Khan
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Francesca Cottini
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Walter Hanel
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Robert Baiocchi
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Catherine Chung
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nina Couette
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alexa Meara
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Wael Jarjour
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Pierluigi Porcu
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology and Department of Cancer Biology, Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - Anjali Mishra
- Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Department of Medical Oncology, Sydney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
| | - John C. Reneau
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Ashley E. Rosko
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Jonathan E. Brammer
- Division of Hematology, Department of Internal Medicine, James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
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Linking the KIR phenotype with STAT3 and TET2 mutations to identify chronic lymphoproliferative disorders of NK cells. Blood 2021; 137:3237-3250. [PMID: 33512451 DOI: 10.1182/blood.2020006721] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/16/2020] [Indexed: 01/27/2023] Open
Abstract
Distinguishing chronic lymphoproliferative disorders of NK cells (CLPD-NK) from reactive NK-cell expansion is challenging. We assessed the value of killer immunoglobulin-like receptor(KIR) phenotyping and targeted high-throughput sequencing in a cohort of 114 consecutive patients with NK cell proliferation, retrospectively assigned to a CLPD-NK group (n = 46) and a reactive NK group (n = 68). We then developed an NK-cell clonality score combining flow cytometry and molecular profiling with a positive predictive value of 93%. STAT3 and TET2 mutations were respectively identified in 27% and 34% of the patients with CLPD-NK, constituting a new diagnostic hallmark for this disease. TET2-mutated CLPD-NK preferentially exhibited a CD16low phenotype, more frequently displayed a lower platelet count, and was associated with other hematologic malignancies such as myelodysplasia. To explore the mutational clonal hierarchy of CLPD-NK, we performed whole-exome sequencing of sorted, myeloid, T, and NK cells and found that TET2 mutations were shared by myeloid and NK cells in 3 of 4 cases. Thus, we hypothesized that TET2 alterations occur in early hematopoietic progenitors which could explain a potential link between CLPD-NK and myeloid malignancies. Finally, we analyzed the transcriptome by RNA sequencing of 7 CLPD-NK and evidenced 2 groups of patients. The first group displayed STAT3 mutations or SOCS3 methylation and overexpressed STAT3 target genes. The second group, including 2 TET2-mutated cases, significantly underexpressed genes known to be downregulated in angioimmunoblastic T-cell lymphoma. Our results provide new insights into the pathogenesis of NK-cell proliferative disorders and, potentially, new therapeutic opportunities.
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Daou H, Hatch LA, Weinkle A, Morey GE, Messina J, Zhang X, Sokol L, Seminario-Vidal L. CD8-positive cutaneous lymphoproliferation associated with large granular lymphocyte leukemia in a patient with X-linked agammaglobulinemia. J Cutan Pathol 2020; 48:567-571. [PMID: 32885480 DOI: 10.1111/cup.13860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/13/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
Patients with primary immunodeficiency are at increased risk for malignancy, especially hematologic neoplasms. This paper reports a unique case of a 47-year-old man with X-linked agammaglobulinemia who presented with progressive asymptomatic violaceous papules and plaques on his face, hands, and trunk for 1 year. Skin biopsies revealed deep, nodular infiltrates of histiocytes and CD8-positive lymphocytes, with a CD4:CD8 ratio of 1:10. Laboratory studies showed cytopenias. Flow cytometry in the skin, blood, and bone marrow (BM) showed a CD3+/CD8+/CD57+ large granular lymphocyte population. BM biopsy showed 30% involvement with these atypical T-cells. T-cell gene rearrangement studies of skin, blood, and BM revealed identical T-cell clones. He was diagnosed with T-large granular lymphocyte leukemia (T-LGLL) with an associated CD8+ cutaneous lymphoproliferation. Skin involvement was suspected to represent infiltration by T-LGLL. However, co-existence of two lymphoproliferative disorders (LPDs), T-LGLL and CD8+ granulomatous LPD, remains a possibility. In general, cutaneous infiltrates associated with LGLL are rare and poorly understood. It has been suggested that they are markers of poor prognosis. Our case report describes skin, blood, and BM findings in an immunosuppressed patient with T-LGLL in detail. These findings have not yet been reported and their significance requires further investigation.
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Affiliation(s)
- Hala Daou
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Leigh A Hatch
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Allison Weinkle
- Department of Dermatology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Gabriel Eli Morey
- Department of Pathology, Moffitt Center and Research Institute, Tampa, Florida, USA.,Department of Cutaneous Oncology, Moffitt Center and Research Institute, Tampa, Florida, USA
| | - Jane Messina
- Department of Pathology, Moffitt Center and Research Institute, Tampa, Florida, USA.,Department of Cutaneous Oncology, Moffitt Center and Research Institute, Tampa, Florida, USA
| | - Xiaohui Zhang
- Department of Pathology, Moffitt Center and Research Institute, Tampa, Florida, USA
| | - Lubomir Sokol
- Department of Malignant Hematology, Moffitt Center and Research Institute, Tampa, Florida, USA
| | - Lucia Seminario-Vidal
- Department of Dermatology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.,Department of Cutaneous Oncology, Moffitt Center and Research Institute, Tampa, Florida, USA
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Naji Rad S, Rafiee B, Raju G, Solhjoo M, Anand P. T-Cell Large Granular Lymphocyte Leukemia in a Patient With Rheumatoid Arthritis. J Investig Med High Impact Case Rep 2020; 8:2324709620941303. [PMID: 32646239 PMCID: PMC7357018 DOI: 10.1177/2324709620941303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Large granular lymphocyte leukemia (LGL) is a clonal, lymphoproliferative disorder with an indolent disease course. T-cell LGL (T-LGL) is the most common type of LGL driven from T-cell lineage (85%). The coexistence of T-LGL with several types of autoimmune disorders, mostly rheumatoid arthritis (RA), has been reported. Felty’s syndrome (FS) is defined by splenomegaly, low neutrophil count, and destructive arthritis and is usually seen in <1% of patients with RA. About 30% to 40% of patients with FS have been reported to have an expansion of large granulated lymphocytes in the circulation. FS and T-LGL are similar in terms of clinical manifestations, response to immunosuppressive therapy, their smoldering course, and immunogenetic findings, proposing FS and T-LGL with RA might be different aspects of a single disease spectrum. In this article, we present a case with long-standing RA who had never been on DMARD (Disease Modifying Anti-Rheumatic Drugs) treatment found to have constitutional symptoms, neutropenia, and splenomegaly, and the patient was diagnosed with T-LGL.
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Affiliation(s)
- Sara Naji Rad
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Gagan Raju
- Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Prachi Anand
- Nassau University Medical Center, East Meadow, NY, USA
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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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Sun H, Wei S, Yang L. Dysfunction of immune system in the development of large granular lymphocyte leukemia. ACTA ACUST UNITED AC 2018; 24:139-147. [PMID: 30334691 DOI: 10.1080/10245332.2018.1535294] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Large granular lymphocyte (LGL) leukemia is a rare type of lymphoproliferative disease caused by clonal antigenic stimulation of T cells and natural killer (NK) cells. METHODS In this review, we focus on the current knowledge of the immunological dysfunctions associated with LGL leukemia and the associated disorders coexistent with this disease. Novel therapeutic options targeting known molecular mechanisms are also discussed. RESULTS AND DISCUSSION The pathogenesis of LGL leukemia involves the accumulation of gene mutations, dysregulated signaling pathways and immunological dysfunction. Mounting evidence indicated that dysregulated survival signaling pathways may be responsible for the immunological dysfunction in LGL leukemia including decreased numbers of neutrophils, dysregulated signal transduction of NK cells, abnormal B-cells, aberrant CD8+ T cells, as well as autoimmune and hematological abnormalities. CONCLUSION A better understanding of the immune dysregulation triggered by LGL leukemia will be beneficial to explore the pathogenesis and potential therapeutic targets for this disease.
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Affiliation(s)
- Houfang Sun
- a Department of Immunology , Tianjin Medical University Cancer Institute and Hospital , Tianjin , People's Republic of China.,b National Clinical Research Center of Cancer , People's Republic of China.,c Key Laboratory of Cancer Immunology and Biotherapy , Tianjin , People's Republic of China.,d Key Laboratory of Cancer Prevention and Therapy , Tianjin , People's Republic of China.,e Tianjin's Clinical Research Center for Cancer , Tianjin , People's Republic of China
| | - Sheng Wei
- f Immunology Program , The H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | - Lili Yang
- a Department of Immunology , Tianjin Medical University Cancer Institute and Hospital , Tianjin , People's Republic of China.,b National Clinical Research Center of Cancer , People's Republic of China.,c Key Laboratory of Cancer Immunology and Biotherapy , Tianjin , People's Republic of China.,d Key Laboratory of Cancer Prevention and Therapy , Tianjin , People's Republic of China.,e Tianjin's Clinical Research Center for Cancer , Tianjin , People's Republic of China
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Dysregulated signaling, proliferation and apoptosis impact on the pathogenesis of TCRγδ+ T cell large granular lymphocyte leukemia. PLoS One 2017; 12:e0175670. [PMID: 28407008 PMCID: PMC5391076 DOI: 10.1371/journal.pone.0175670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/29/2017] [Indexed: 11/20/2022] Open
Abstract
TCRγδ+ T-LGL leukemia is a rare form of chronic mature T cell disorders in elderly, which is generally characterized by a persistently enlarged CD3+CD57+TCRγδ+ large granular lymphocyte population in the peripheral blood with a monoclonal phenotype. Clinically, the disease is heterogeneous, most patients being largely asymptomatic, although neutropenia, fatigue and B symptoms and underlying diseases such as autoimmune diseases or malignancies are also often observed. The etiology of TCRγδ+ T-LGL proliferations is largely unknown. Here, we aimed to investigate underlying molecular mechanisms of these rare proliferations by performing gene expression profiling of TCRγδ+ T-LGL versus normal TCRγδ+ T cell subsets. From our initial microarray dataset we observed that TCRγδ+ T-LGL leukemia forms a separate group when compared with different healthy control TCRγδ+ T cell subsets, correlating best with the healthy TemRA subset. The lowest correlation was seen with the naive subset. Based on specific comparison between healthy control cells and TCRγδ+ T-LGL leukemia cells we observed up-regulation of survival, proliferation and hematopoietic system related genes, with a remarkable down-regulation of apoptotic pathway genes. RQ-PCR validation of important genes representative for the dataset, including apoptosis (XIAP, CASP1, BCLAF1 and CFLAR), proliferation/development (ID3) and inflammation (CD28, CCR7, CX3CR1 and IFNG) processes largely confirmed the dysregulation in proliferation and apoptosis. Based on these expression data we conclude that TCRγδ+ T-LGL leukemia is likely the result of an underlying aberrant molecular mechanisms leading to increased proliferation and reduced apoptosis.
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LGL leukemia: from pathogenesis to treatment. Blood 2017; 129:1082-1094. [PMID: 28115367 DOI: 10.1182/blood-2016-08-692590] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/27/2016] [Indexed: 11/20/2022] Open
Abstract
Large granular lymphocyte (LGL) leukemia has been recognized by the World Health Organization classifications amongst mature T-cell and natural killer (NK) cell neoplasms. There are 3 categories: chronic T-cell leukemia and NK-cell lymphocytosis, which are similarly indolent diseases characterized by cytopenias and autoimmune conditions as opposed to aggressive NK-cell LGL leukemia. Clonal LGL expansion arise from chronic antigenic stimulation, which promotes dysregulation of apoptosis, mainly due to constitutive activation of survival pathways including Jak/Stat, MapK, phosphatidylinositol 3-kinase-Akt, Ras-Raf-1, MEK1/extracellular signal-regulated kinase, sphingolipid, and nuclear factor-κB. Socs3 downregulation may also contribute to Stat3 activation. Interleukin 15 plays a key role in activation of leukemic LGL. Several somatic mutations including Stat3, Stat5b, and tumor necrosis factor alpha-induced protein 3 have been demonstrated recently in LGL leukemia. Because these mutations are present in less than half of the patients, they cannot completely explain LGL leukemogenesis. A better mechanistic understanding of leukemic LGL survival will allow future consideration of a more targeted therapeutic approach than the current practice of immunosuppressive therapy.
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Bárcena P, Jara-Acevedo M, Tabernero MD, López A, Sánchez ML, García-Montero AC, Muñoz-García N, Vidriales MB, Paiva A, Lecrevisse Q, Lima M, Langerak AW, Böttcher S, van Dongen JJM, Orfao A, Almeida J. Phenotypic profile of expanded NK cells in chronic lymphoproliferative disorders: a surrogate marker for NK-cell clonality. Oncotarget 2016; 6:42938-51. [PMID: 26556869 PMCID: PMC4767482 DOI: 10.18632/oncotarget.5480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/27/2015] [Indexed: 01/08/2023] Open
Abstract
Currently, the lack of a universal and specific marker of clonality hampers the diagnosis and classification of chronic expansions of natural killer (NK) cells. Here we investigated the utility of flow cytometric detection of aberrant/altered NK-cell phenotypes as a surrogate marker for clonality, in the diagnostic work-up of chronic lymphoproliferative disorders of NK cells (CLPD-NK). For this purpose, a large panel of markers was evaluated by multiparametric flow cytometry on peripheral blood (PB) CD56low NK cells from 60 patients, including 23 subjects with predefined clonal (n = 9) and polyclonal (n = 14) CD56low NK-cell expansions, and 37 with CLPD-NK of undetermined clonality; also, PB samples from 10 healthy adults were included. Clonality was established using the human androgen receptor (HUMARA) assay. Clonal NK cells were found to show decreased expression of CD7, CD11b and CD38, and higher CD2, CD94 and HLADR levels vs. normal NK cells, together with a restricted repertoire of expression of the CD158a, CD158b and CD161 killer-associated receptors. In turn, NK cells from both clonal and polyclonal CLPD-NK showed similar/overlapping phenotypic profiles, except for high and more homogeneous expression of CD94 and HLADR, which was restricted to clonal CLPD-NK. We conclude that the CD94hi/HLADR+ phenotypic profile proved to be a useful surrogate marker for NK-cell clonality.
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Affiliation(s)
- Paloma Bárcena
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - María Jara-Acevedo
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | | | - Antonio López
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - María Luz Sánchez
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Andrés C García-Montero
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Noemí Muñoz-García
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - María Belén Vidriales
- Department of Hematology and Institute of Biomedical Research of Salamanca (IBSAL), University Hospital of Salamanca, Salamanca, Spain
| | - Artur Paiva
- Unidade de Gestão Operacional em Citometria, Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Análises Clínicas e Saúde Pública, Coimbra,Portugal
| | - Quentin Lecrevisse
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Margarida Lima
- Department of Hematology, Laboratory of Cytometry, Hospital de Santo António, Centro Hospitalar do Porto, and Unit for Multidisciplinary Research in Biomedicine (UMIB), Porto, Portugal
| | - Anton W Langerak
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sebastian Böttcher
- Medical Clinic II, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jacques J M van Dongen
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Alberto Orfao
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Julia Almeida
- Cancer Research Centre (IBMCC, CSIC-USAL), Institute of Biomedical Research of Salamanca (IBSAL), (NUCLEUS) and Department of Medicine, University of Salamanca, Salamanca, Spain
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15
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Abstract
Secondary autoimmune cytopenias in chronic lymphocytic leukemia are distinct clinical entities that require specific management. These autoimmune disorders have a complex pathogenesis that involves both the leukemic cells and the immune environment in which they exist. The mechanism is not the same in all cases, and to varying degrees involves the chronic lymphocytic leukemia (CLL) cells in antibody production, antigen presentation, and stimulation of T cells and bystander polyclonal B cells. Diagnosis of autoimmune cytopenias can be challenging as it is difficult to differentiate between autoimmunity and bone marrow failure due to disease progression. There is a need to distinguish these causes, as prognosis and treatment are not the same. Evidence regarding treatment of secondary autoimmune cytopenias is limited, but many effective options exist and treatment can be selected with severity of disease and patient factors in mind. With new agents to treat CLL coming into widespread clinical use, it will be important to understand how these will change the natural history and treatment of autoimmune cytopenias.
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Affiliation(s)
- Kerry A Rogers
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jennifer A Woyach
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH.
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16
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Yabe M, Medeiros LJ, Wang SA, Konoplev S, Ok CY, Loghavi S, Lu G, Flores L, Khoury JD, Cason RC, Young KH, Miranda RN. Clinicopathologic, Immunophenotypic, Cytogenetic, and Molecular Features of γδ T-Cell Large Granular Lymphocytic Leukemia: An Analysis of 14 Patients Suggests Biologic Differences With αβ T-Cell Large Granular Lymphocytic Leukemia. [corrected]. Am J Clin Pathol 2015; 144:607-19. [PMID: 26386082 DOI: 10.1309/ajcpjsa1e1ywszey] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES T-cell large granular lymphocytic (T-LGL) leukemia is a rare disorder in which the neoplastic cells usually express the αβ T-cell receptor (TCR). To determine the significance of γδ TCR expression in this leukemia, we compared the clinicopathologic, immunophenotypic, and genetic features of patients with T-LGL leukemia expressing γδ TCR or αβ TCR. METHODS We used the World Health Organization classification criteria to confirm the diagnosis. All patients were diagnosed and treated at our institution. RESULTS We identified 14 patients with γδ T-LGL leukemia, 11 men and three women; six (43%) patients had a history of rheumatoid arthritis, 10 (71%) had neutropenia, four (29%) had thrombocytopenia, and three (21%) had anemia. Eight (67%) of 12 patients had a CD4-/CD8- phenotype, and four (33%) had a CD4-/CD8+ phenotype. The median overall survival was 62 months. Patients with γδ T-LGL leukemia were more likely to have rheumatoid arthritis (P = .04), lower absolute neutrophil count (P = .04), lower platelet count (P = .004), and a higher frequency of the CD4-/CD8- phenotype (P < .0001). However, there was no significant difference in overall survival between the two groups (P = .64). CONCLUSIONS Although patients with γδ and αβ T-LGL leukemia show some different clinical or phenotypic features, overall survival is similar, suggesting that γδ TCR expression does not carry prognostic significance.
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Affiliation(s)
- Mariko Yabe
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - L. Jeffrey Medeiros
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sa A. Wang
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sergej Konoplev
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Chi Young Ok
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sanam Loghavi
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Gary Lu
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Lauren Flores
- Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Joseph D. Khoury
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - R. Craig Cason
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Ken H. Young
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Roberto N. Miranda
- Departments of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston
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17
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Kataria A, Cohen E, Saad E, Atallah E, Bresnahan B. Large granular lymphocytic leukemia presenting late after solid organ transplantation: a case series of four patients and review of the literature. Transplant Proc 2014; 46:3278-81. [PMID: 25240311 DOI: 10.1016/j.transproceed.2014.05.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a significant complication of solid organ transplantation. Most PTLD is of the B-cell subtype, although T-cell subtype PTLD uncommonly occurs. T-cell PTLDs are usually aggressive neoplasms and shorten patient and allograft survivals significantly. We present a single-center case series of 4 patients who developed T-cell large granular lymphocytic (LGL) leukemia, a rare T-cell PTLD characterized by large granular lymphocytes that have characteristic azurophilic granules and a highly variable clinical course.
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Affiliation(s)
- A Kataria
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - E Cohen
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Medicine, Veterans Administration Zablocki Medical Center, Milwaukee, Wisconsin
| | - E Saad
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - E Atallah
- Division of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B Bresnahan
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
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18
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Gattazzo C, Teramo A, Passeri F, De March E, Carraro S, Trimarco V, Frezzato F, Berno T, Barilà G, Martini V, Piazza F, Trentin L, Facco M, Semenzato G, Zambello R. Detection of monoclonal T populations in patients with KIR-restricted chronic lymphoproliferative disorder of NK cells. Haematologica 2014; 99:1826-33. [PMID: 25193965 DOI: 10.3324/haematol.2014.105726] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The etiology of chronic large granular lymphocyte proliferations is largely unknown. Although these disorders are characterized by the expansion of different cell types (T and natural killer) with specific genetic features and abnormalities, several lines of evidence suggest a common pathogenetic mechanism. According to this interpretation, we speculated that in patients with natural killer-type chronic lymphoproliferative disorder, together with natural killer cells, also T lymphocytes undergo a persistent antigenic pressure, possibly resulting in an ultimate clonal T-cell selection. To strengthen this hypothesis, we evaluated whether clonal T-cell populations were detectable in 48 patients with killer immunoglobulin-like receptor-restricted natural killer-type chronic lymphoproliferative disorder. At diagnosis, in half of the patients studied, we found a clearly defined clonal T-cell population, despite the fact that all cases presented with a well-characterized natural killer disorder. Follow-up analysis confirmed that the TCR gamma rearrangements were stable over the time period evaluated; furthermore, in 7 patients we demonstrated the appearance of a clonal T subset that progressively matures, leading to a switch between killer immunoglobulin-like receptor-restricted natural killer-type disorder to a monoclonal T-cell large granular lymphocytic leukemia. Our results support the hypothesis that a common mechanism is involved in the pathogenesis of these disorders.
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Affiliation(s)
- Cristina Gattazzo
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | | | - Francesca Passeri
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Elena De March
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine
| | - Samuela Carraro
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine
| | - Valentina Trimarco
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Federica Frezzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine
| | - Gregorio Barilà
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine
| | - Veronica Martini
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Francesco Piazza
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Monica Facco
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
| | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine Venetian Institute of Molecular Medicine (VIMM), Padua, Italy
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19
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Cheng J, Talamo G, Malysz J, Ochmann M, Lamy T, Loughran TP. Report of 6 cases of large granular lymphocytic leukemia and plasma cell dyscrasia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e169-72. [PMID: 25037886 DOI: 10.1016/j.clml.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/27/2014] [Accepted: 04/03/2014] [Indexed: 11/24/2022]
Affiliation(s)
- Jihua Cheng
- Division of Hematology and Oncology, Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA.
| | - Giampaolo Talamo
- Division of Hematology and Oncology, Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA
| | - Jozef Malysz
- Department of Anatomic & Clinical Pathology and Hematopathology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Marlene Ochmann
- Department of Hematology, Service d' Hematologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Thierry Lamy
- Department of Hematology, Service d' Hematologie, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Thomas P Loughran
- Division of Hematology and Oncology, Department of Medicine, Penn State Hershey Cancer Institute, Hershey, PA
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20
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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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21
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Lack of common TCRA and TCRB clonotypes in CD8(+)/TCRαβ(+) T-cell large granular lymphocyte leukemia: a review on the role of antigenic selection in the immunopathogenesis of CD8(+) T-LGL. Blood Cancer J 2014; 4:e172. [PMID: 24413066 PMCID: PMC3913939 DOI: 10.1038/bcj.2013.70] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 10/30/2013] [Accepted: 11/05/2013] [Indexed: 11/08/2022] Open
Abstract
Clonal CD8+/T-cell receptor (TCR)αβ+ T-cell large granular lymphocyte (T-LGL) proliferations constitute the most common subtype of T-LGL leukemia. Although the etiology of T-LGL leukemia is largely unknown, it has been hypothesized that chronic antigenic stimulation contributes to the pathogenesis of this disorder. In the present study, we explored the association between expanded TCR-Vβ and TCR-Vα clonotypes in a cohort of 26 CD8+/TCRαβ+ T-LGL leukemia patients, in conjunction with the HLA-ABC genotype, to find indications for common antigenic stimuli. In addition, we applied purpose-built sophisticated computational tools for an in-depth evaluation of clustering of TCRβ (TCRB) complementarity determining region 3 (CDR3) amino-acid LGL clonotypes. We observed a lack of clear TCRA and TCRB CDR3 homology in CD8+/TCRαβ+ T-LGL, with only low level similarity between small numbers of cases. This is in strong contrast to the homology that is seen in CD4+/TCRαβ+ T-LGL and TCRγδ+ T-LGL and thus underlines the idea that the LGL types have different etiopathogenesis. The heterogeneity of clonal CD8+/TCRαβ+ T-LGL proliferations might in fact suggest that multiple pathogens or autoantigens are involved.
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22
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Mailloux AW, Zhang L, Moscinski L, Bennett JM, Yang L, Yoder SJ, Bloom G, Wei C, Wei S, Sokol L, Loughran TP, Epling-Burnette PK. Fibrosis and subsequent cytopenias are associated with basic fibroblast growth factor-deficient pluripotent mesenchymal stromal cells in large granular lymphocyte leukemia. THE JOURNAL OF IMMUNOLOGY 2013; 191:3578-93. [PMID: 24014875 DOI: 10.4049/jimmunol.1203424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cytopenias occur frequently in systemic lupus erythematosus, rheumatoid arthritis, Felty's syndrome, and large granular lymphocyte (LGL) leukemia, but the bone marrow microenvironment has not been systematically studied. In LGL leukemia (n = 24), retrospective analysis of bone marrow (BM) histopathology revealed severe fibrosis in 15 of 24 patients (63%) in association with the presence of cytopenias, occurrence of autoimmune diseases, and splenomegaly, but was undetectable in control cases with B cell malignancies (n = 11). Fibrosis severity correlated with T cell LGL cell numbers in the BM, but not in the periphery, suggesting deregulation is limited to the BM microenvironment. To identify fibrosis-initiating populations, primary mesenchymal stromal cultures (MSCs) from patients were characterized and found to display proliferation kinetics and overabundant collagen deposition, but displayed normal telomere lengths and osteoblastogenic, chondrogenic, and adipogenic differentiation potentials. To determine the effect of fibrosis on healthy hematopoietic progenitor cells (HPCs), bioartificial matrixes from rat tail or purified human collagen were found to suppress HPC differentiation and proliferation. The ability of patient MSCs to support healthy HSC proliferation was significantly impaired, but could be rescued with collagenase pretreatment. Clustering analysis confirmed the undifferentiated state of patient MSCs, and pathway analysis revealed an inverse relationship between cell division and profibrotic ontologies associated with reduced basic fibroblast growth factor production, which was confirmed by ELISA. Reconstitution with exogenous basic fibroblast growth factor normalized patient MSC proliferation, collagen deposition, and HPC supportive function, suggesting LGL BM infiltration and secondary accumulation of MSC-derived collagen is responsible for hematopoietic failure in autoimmune-associated cytopenias in LGL leukemia.
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Affiliation(s)
- Adam W Mailloux
- Immunology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612
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23
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Wlodarski MW, Schade AE, Maciejewski JP. T-large granular lymphocyte leukemia: current molecular concepts. Hematology 2013; 11:245-56. [PMID: 17178663 DOI: 10.1080/10245330600774793] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
T-large granular lymphocyte (T-LGL) leukemia is a chronic and often indolent T cell lymphoproliferation characterized by extreme expansion of a semi-autonomous cytotoxic T lymphocyte (CTL) clone. Clinically, T-LGL can be associated with various cytopenias; neutropenia constitutes the most frequent manifestation. LGL clone represents a pathologic counterpart of the cytotoxic effector T cell but an abnormal memory CD8 cell seems to provide the supply of the matured LGL population. Analysis of clonal T cell receptor (TCR) rearrangement and complementarity determining region 3 (CDR3) of the TCR beta-chain is a useful tool to investigate clonal expansions, track the frequency of expanded clones and also clinically useful to monitor the response to therapy. The lessons learned from molecular analysis of clonal repertoire support a clinically-derived conclusion that the LGL clone arises in the context of an initially polyclonal immune response or an autoimmune process. Consequently, specific manifestations of T-LGL may be a result of the recognition spectrum of the transformed clone and the cytokines it produces. Due to the often monoclonal manifestation, T-LGL constitutes a suitable model to investigate polyclonal CTL-mediated processes. Application of new technologies, including TCR repertoire analysis by sequencing, clonotypic quantitative PCR and VB flow cytometry facilitate clinical diagnosis and may allow insights into the regulation of TCR repertoire and consequences resulting from the contraction of clonal diversity.
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MESH Headings
- Adult
- Aged
- Autoimmune Diseases/epidemiology
- CD4-Positive T-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/pathology
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Viral
- Clone Cells/pathology
- Comorbidity
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Leukemic
- Gene Rearrangement, T-Lymphocyte/genetics
- Herpesviridae Infections/complications
- Humans
- Killer Cells, Natural/pathology
- Leukemia, T-Cell/diagnosis
- Leukemia, T-Cell/epidemiology
- Leukemia, T-Cell/genetics
- Leukemia, T-Cell/pathology
- Leukemia, T-Cell/physiopathology
- Leukemia, T-Cell/virology
- Leukocyte Count
- Leukocytosis/diagnosis
- Lymphocyte Activation
- Lymphoproliferative Disorders/epidemiology
- Male
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Retroviridae Infections/complications
- T-Lymphocytes, Cytotoxic/pathology
- Tumor Virus Infections/epidemiology
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Affiliation(s)
- Marcin W Wlodarski
- Experimental Hematology and Hematopoiesis Section, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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24
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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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25
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Schrenk KG, Krokowski M, Feller AC, Bernhard V, Mügge LO, Oelzner P, Wolf G, Hochhaus A, Neumann T. Clonal T-LGL population mimicking leukemia in Felty's syndrome--part of a continuous spectrum of T-LGL proliferations? Ann Hematol 2013; 92:985-7. [PMID: 23322212 DOI: 10.1007/s00277-012-1649-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 12/01/2012] [Indexed: 10/27/2022]
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26
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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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27
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Turesson C, Matteson EL. Malignancy as a comorbidity in rheumatic diseases. Rheumatology (Oxford) 2012; 52:5-14. [DOI: 10.1093/rheumatology/kes189] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Petsa PK, Karamoutsios A, Dova L, Benetatos L, Petsiou A, Kolaitis N, Georgopoulos A, Vartholomatos G. Asymptomatic T-cell large granular lymphocyte leukemia with an unusual immunophenotype. Clin Pract 2012; 2:e68. [PMID: 24765467 PMCID: PMC3981314 DOI: 10.4081/cp.2012.e68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 11/22/2022] Open
Abstract
T-cell large granular lymphocyte (T-LGL) leukemia represents a clonal proliferation of cytotoxic T-cells which etiology has not been entirely elucidated. However, CD4+, CD4−, CD8−, CD4+, CD8+ cases have been described. The disease is usually characterized by cytopenias and a modest lymphocytosis. The majority of patients with T-LGL leukemia remains asymptomatic for a long period and will require treatment later during the course of their disease. Hereby we describe a case of T-LGL leukemia diagnosed by flow cytometry, which presented indolent course and required no treatment so far.
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Affiliation(s)
- Panagiota K Petsa
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | | | - Lefkothea Dova
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | - Leonidas Benetatos
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | - Asimina Petsiou
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
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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
PURPOSE OF REVIEW Patients with chronic large granular lymphocyte (LGL) leukemia often have rheumatoid arthritis (RA), neutropenia and splenomegaly, thereby resembling the manifestations observed in patients with Felty's syndrome, which is a rare complication of RA characterized by neutropenia and splenomegaly. Both entities have similar clinical and laboratory presentation, as well as a common genetic determinant, HLA-DR4, indicating they may be part of the same disease spectrum. This review paper seeks to discuss the underlying pathogenesis and therapeutic algorithm of RA, neutropenia and splenomegaly in the spectrum of LGL leukemia and Felty's syndrome. RECENT FINDINGS We hypothesize that there may be a common pathogenic mechanism between LGL leukemia and typical Felty's syndrome. Phenotypic and functional data have strongly suggested that CD3 LGL leukemia is antigen-activated. Aberrations in the T-cell repertoire with the emergence of oligoclonal/clonal lymphoid populations have been found to play a pivotal role in pathogenesis of RA. The biologic properties of the pivotal T cell involved in RA pathogenesis are remarkably similar to those in leukemic LGL. SUMMARY RA-associated T-cell LGL leukemia and articular manifestations of typical Felty's syndrome are not distinguishable. A common pathogenetic link between LGL leukemia and RA is proposed.
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Affiliation(s)
- Xin Liu
- Department of Medicine, Penn State Hershey Cancer Institute, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033-0850, 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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Angelini DF, Zambello R, Galandrini R, Diamantini A, Placido R, Micucci F, Poccia F, Semenzato G, Borsellino G, Santoni A, Battistini L. NKG2A inhibits NKG2C effector functions of γδ T cells: implications in health and disease. J Leukoc Biol 2010; 89:75-84. [PMID: 20952657 DOI: 10.1189/jlb.0710413] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The CD94/NKG2 complex is expressed on T and NK lymphocytes. CD94 molecules covalently associate to activating or inhibitory NKG2 molecules, and their expression finely tunes cell responses. Human γδ T cells express several NKRs. Expression of these receptors is confined to the cytolytic Vδ2 subset, which coexpresses the FcγRIII CD16 and CD45RA and has been defined as Vγ9Vδ2 T(EMRA) cells. We show that the CD94/NKG2C complex, associated with KARAP/DAP12, is fully functional in γδ T cells, as determined by measuring IFN-γ production, T cell proliferation, and cytolytic activity by γδ lymphocytes. In contrast, NKG2A expression was found on all γδ T cell memory subsets, suggesting a crucial role of the inhibitory signal provided by this receptor on γδ T cell responses. Moreover, we found Vγ9Vδ2 T(EMRA), NK, and CD8+ αβ T cells coexpressing NKG2A and NKG2C receptors. Functional experiments showed that the inhibitory signal mediated by the NKG2A receptor prevails when double-positive cells are activated. Finally, NKG2A expression on γδ LDGL correlates with asymptomatic pathology, even in the presence of NKG2C coexpression, whereas in symptomatic patients affected by severe disease, the inhibitory NKG2A receptor is absent, and a variety of activatory NKRs was found. We propose that the silent behavior of γδ cells in LDGL patients is a result of effective inhibitory HLA class I receptors.
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Affiliation(s)
- Daniela F Angelini
- Neuroimmunology Unit, Fondazione Santa Lucia, Scientific Institute (I.R.C.C.S.), Rome, Italy
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Howard MT, Bejanyan N, Maciejewski JP, Hsi ED. T/NK large granular lymphocyte leukemia and coexisting monoclonal B-cell lymphocytosis-like proliferations. An unrecognized and frequent association. Am J Clin Pathol 2010; 133:936-41. [PMID: 20472852 DOI: 10.1309/ajcpiil1y5qxtibp] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
T-cell large granular lymphocyte leukemia (T-LGLL) is a T-cell lymphoproliferative disorder that has recently been associated with B-cell dyscrasias on a spectrum ranging from dysgammaglobulinemia to lymphoma. To investigate the relationship between clonal B-cell and LGLL lymphoproliferations, we systematically studied lymphocytes in 57 patients with T-LGLL or NK lymphocytosis using flow cytometric methods sensitive to low-level B-cell populations. We identified 16 patients (28%) with abnormal B-cell populations; 9 (16%) of the patients had no known history of a B-cell lymphoproliferative disorder. We characterized these abnormal B-cell populations as monoclonal B-cell lymphocytosis and report a high frequency of monoclonal B-cell lymphocytosis in T/NK LGLL. Our findings suggest that certain pathologic factors may operate in patients with T/NK LGLL to drive low-level clonal B-cell proliferations.
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35
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Wood KL, Voss OH, Huang Q, Parihar A, Mehta N, Batra S, Doseff AI. The small heat shock protein 27 is a key regulator of CD8+ CD57+ lymphocyte survival. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2010; 184:5582-8. [PMID: 20385876 PMCID: PMC3253717 DOI: 10.4049/jimmunol.0902953] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Differences in CD8(+)CD57(-) and CD8(+)CD57(+) lymphocyte lifespan have been documented. Lower numbers and shorter lifespan are characteristic of CD8(+)CD57(+) in normal individuals. However, CD8(+)CD57(+) are expanded in certain disease states including T cell large granular leukemia and other hematologic malignancies. The mechanisms responsible for the differences in CD8(+)CD57(-) and CD8(+)CD57(+) lifespan remain elusive. In this study, we demonstrate that the small heat shock protein (Hsp) 27 is a key regulator of CD8(+)CD57(+) lymphocyte lifespan. We found that Hsp27 expression is significantly lower in CD8(+)CD57(+) than in CD8(+)CD57(-) lymphocytes. In contrast, Hsp60 and Hsp70 are expressed at comparable levels. Unlike other antiapoptotic Bcl-2-like molecules, the expression of Hsp27 tightly correlates with CD8(+)CD57(+) and CD8(+)CD57(-) lifespan. We demonstrate that Hsp27 overexpression in CD8(+)CD57(+) lymphocytes to levels found normally in CD8(+)CD57(-) lymphocytes decreased apoptosis. Accordingly, silencing of Hsp27 in CD8(+)CD57(-) lymphocytes increased apoptosis. Collectively these results demonstrate that Hsp27 is a critical regulator of normal CD8(+)CD57(+) lifespan supporting its use as a marker of lifespan in this lineage, and suggest a mechanism responsible for the decreased apoptosis and clonal expansion characteristic of certain disease states.
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Affiliation(s)
- Karen L. Wood
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH 43210
| | - Oliver H. Voss
- Department of Molecular Genetics, The Ohio State University, Columbus, OH 43210
| | - Qin Huang
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Arti Parihar
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Neeraj Mehta
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Sanjay Batra
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
| | - Andrea I. Doseff
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210
- The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH 43210
- Department of Molecular Genetics, The Ohio State University, Columbus, OH 43210
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Viny AD, Clemente MJ, Jasek M, Askar M, Ishwaran H, Nowacki A, Zhang A, Maciejewski JP. MICA polymorphism identified by whole genome array associated with NKG2D-mediated cytotoxicity in T-cell large granular lymphocyte leukemia. Haematologica 2010; 95:1713-21. [PMID: 20460636 DOI: 10.3324/haematol.2010.021865] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Large granular lymphocyte leukemia is a semi-autonomous clonal proliferation of cytotoxic T cells accompanied by immune cytopenias and various autoimmune conditions. Due to the rarity of this disease and its association with autoimmune diseases, a theoretical germline or somatic mutation might have significant penetrance, thus enabling detection, even from samples of suboptimal size, through genome-wide association studies. DESIGN AND METHODS To investigate a non-mendelian genetic predisposition to large granular lymphocyte leukemia, we used a step-wise method for gene discovery. First, a modified 'random forests' technique was used for candidate gene identification: this was followed by traditional allele-specific polymerase chain reaction, sequencing modalities, and mechanistic assays. RESULTS Our analysis found an association with MICA, a non-peptide-presenting, tightly regulated, stress-induced MHC-like molecule and cognate receptor for NKG2D, found abundantly on large granular lymphocyte leukemia cells. Sequencing of germline DNA revealed a higher frequency of MICA*00801/A5.1 in patients with large granular lymphocyte leukemia than in matched controls (64% versus 41%, P<0.001, homozygous 40% versus 15%, P<0.001). Flow cytometry was employed to determine the expression of MICA within hematologic compartments, showing that the signal intensity of MICA was increased in granulocytes from neutropenic patients with large granular lymphocyte leukemia in comparison with that in controls (P=0.033). Furthermore, neutrophil counts were inversely correlated with MICA expression (R(2)=0.50, P=0.035). Finally, large granular lymphocyte leukemia cells were able to selectively kill MICA(+) Ba/F3 lymphocytes transfected with human MICA*019 in a dose-dependent manner compared to naïve cells (P<0.001), an effect mitigated by administration of an anti-NKG2D antibody (P=0.033). CONCLUSIONS Our results illustrate that MICA-NKG2D played a role in disease pathogenesis in the majority of patients in our cohort of cases of large granular lymphocyte leukemia and further investigation into this signaling axis may provide potent therapeutic targets.
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Affiliation(s)
- Aaron D Viny
- Department of Translational Hematologic and Oncologic Research, Taussig Cancer Center R/40, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, USA
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Large granular lymphocytic (LGL) leukemia in an adult with Down syndrome (47,XX,+21). Leuk Res 2010; 34:e125-7. [DOI: 10.1016/j.leukres.2009.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 11/21/2009] [Accepted: 11/22/2009] [Indexed: 11/19/2022]
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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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Visco C, Rodeghiero F. Immune thrombocytopenia in lymphoproliferative disorders. Hematol Oncol Clin North Am 2010; 23:1261-74. [PMID: 19932433 DOI: 10.1016/j.hoc.2009.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lymphoproliferative disorders are recognized as a common cause of secondary immune thrombocytopenia (ITP). The mechanisms involved in the pathogenesis of ITP associated with lymphoproliferative disorders are heterogeneous and often linked to the presence and activity of the malignant clone. A better understanding of the responsible mechanisms leading to ITP in each disease may allow for targeted treatment decisions, avoiding unwarranted immunosuppression and bleeding complications.
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Affiliation(s)
- Carlo Visco
- Division of Hematology, Department of Cell Therapy and Hematology, San Bortolo Hospital, Via Rodolfi 37, Vicenza 36100, Italy
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40
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Shah MV, Zhang R, Loughran TP. Never say die: survival signaling in large granular lymphocyte leukemia. ACTA ACUST UNITED AC 2010; 9 Suppl 3:S244-53. [PMID: 19778848 DOI: 10.3816/clm.2009.s.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Large granular lymphocyte (LGL) leukemia is a rare disorder of mature cytotoxic T or natural killer cells. Large granular lymphocyte leukemia is characterized by the accumulation of cytotoxic cells in blood and infiltration in the bone marrow, liver, and spleen. Herein, we review clinical features of LGL leukemia. We focus our discussion on known survival signals believed to play a role in the pathogenesis of LGL leukemia and their potential therapeutic implications.
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41
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Thomas A, Perzova R, Abbott L, Benz P, Poiesz MJ, Dube S, Loughran T, Ferrer J, Sheremata W, Glaser J, Leon-Ponte M, Poiesz BJ. LGL leukemia and HTLV. AIDS Res Hum Retroviruses 2010; 26:33-40. [PMID: 20047475 DOI: 10.1089/aid.2009.0124] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Samples were obtained from 53 large granular lymphocytic leukemia (LGLL) patients and 10,000 volunteer blood donors (VBD). Sera were screened in an HTLV-1 enzyme immunoassay (EIA) and further analyzed in peptide-specific Western blots (WB). DNAs were analyzed by HTLV-1, -2, -3, and -4-specific PCR. Forty four percent of LGLL patients vs. 0.12 % of VBD had anti-HTLV antibodies via EIA (p < 0.001). WB and PCR revealed that four LGLL patients (7.5%) vs. one VBD patient (0.01%) were infected with HTLV-2 (p < 0.001), suggesting an HTLV-2 etiology in a minority of cases. No LGLL patient was positive for HTLV-1, -3, or -4, whereas only one EIA-positive VBD was positive for HTLV-1 and none for HTLV-3 or -4. The HTLV EIA-positive, PCR-negative LGLL patients' sera reacted to epitopes within HTLV p24 gag and gp21 env. Other then the PTLV/BLV viruses, human endogenous retroviral element HERV K10 was the only sequence homologous to these two HTLV peptides, raising the possibility of cross-reactivity. Although three LGLL patients (5.7%) vs. none of 110 VBD patients tested positive for antibodies to the homologous HERV K10 peptide (p = 0.03), the significance of the anti-HTLV seroreactivity observed in many LGLL patients remains unclear. Interestingly, out of 36 HTLV-1-positive control subjects, 3 (8%) (p = 0.014) were positive for antibodies to HERV K10; all three had myelopathy. Out of 64 HTLV-2-positive control subjects 16 (25%) (p = <0.001) were positive for HERV K10 antibodies, and 4 (6%) of these had myelopathy. Out of 22 subjects with either HTLV-1 or -2 myelopathy, 7 (31.8%) were positive for HERV K10 antibodies, and out of 72 HTLV-infected subjects without myelopathy, 12 (16.7%) were positive for anti-HERV K10 antibodies (p = 0.11). The prevalence of anti-HERV K10 antibodies in these populations and the clinical implications thereof need to be pursued further.
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Affiliation(s)
- Anish Thomas
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
| | - Raisa Perzova
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
| | - Lynn Abbott
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
| | - Patricia Benz
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
| | - Michael J. Poiesz
- Department of Medicine, New York University Medical Center, New York, New York 13210
| | - Syamalima Dube
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
| | - Thomas Loughran
- Penn State Cancer Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17103
| | - Jorge Ferrer
- Comparative Leukemia and Retroviruses Unit, New Bolton Center University of Pennsylvania, Kennett Square, Pennsylvania 19348
| | | | - Jordan Glaser
- Division of Infectious Disease, Department of Medicine, Staten Island Hospital, New York, New York 10305
| | - Matilde Leon-Ponte
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Bernard J. Poiesz
- Division of Hematology/Oncology, Department of Medicine, State University of New York, Upstate Medical University, Syracuse, New York 13202
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Osuji N, Del Giudice I, Matutes E, Morilla A, Owusu-Ankomah K, Morilla R, Dunlop A, Catovksy D. CD52 expression in T-cell large granular lymphocyte leukemia – Implications for treatment with alemtuzumab. Leuk Lymphoma 2009; 46:723-7. [PMID: 16019510 DOI: 10.1080/10428190500052156] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Few reports on the successful treatment of T-cell large granular lymphocyte (LGL) leukemia with the humanized anti-CD52 monoclonal antibody alemtuzumab are emerging in the literature. The expression of CD52 by LGLs has not been previously investigated. Using semi-quantitative 2- and 3-color flow cytometry, we documented the expression of CD52 in 100% of abnormal cells in T-cell LGL leukemia (n = 11) and natural killer (NK) cell LGL leukemia (n = 2), and showed no significant difference in CD52 expression between T-cell prolymphocytic leukemia (PLL) and T-cell LGL leukemia. Higher CD52 expression has been noted in responders to alemtuzumab in T-cell PLL and in chronic lymphocytic leukemia (CLL), a B-cell disorder. The strong and consistent expression of CD52 shown here highlights the potential role of alemtuzumab in the treatment of refractory T-cell LGL leukemia and possibly aggressive NK cell leukemia.
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MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antigens, CD/biosynthesis
- Antigens, Neoplasm/biosynthesis
- Antineoplastic Agents/therapeutic use
- CD52 Antigen
- Flow Cytometry
- Glycoproteins/biosynthesis
- Humans
- Immunophenotyping
- Leukemia, Lymphoid/drug therapy
- Leukemia, Lymphoid/immunology
- Leukemia, T-Cell/drug therapy
- Leukemia, T-Cell/immunology
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Affiliation(s)
- N Osuji
- Section of Haemato-Oncology, Royal Marsden NHS Trust and Institute of Cancer Research, London, UK
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Abstract
The leukemias of mature B cells and T cells are a limited set of diseases in which blood and bone marrow are the primary sites of involvement. Although they may superficially resemble one another, they have distinct clinical and pathologic features and must be distinguished from one another. In this article, the major clinical, morphologic, phenotypic, and molecular genetic features of the mature B- and T-cell leukemias are reviewed, and differential diagnostic considerations are discussed.
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Affiliation(s)
- Eric D Hsi
- Section of Hematopathology, Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
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44
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Balsamo M, Zambello R, Teramo A, Pedrazzi M, Sparatore B, Scordamaglia F, Pende D, Mingari MC, Moretta L, Moretta A, Semenzato G, Vitale M. Analysis of NK cell/DC interaction in NK-type lymphoproliferative disease of granular lymphocytes (LDGL): role of DNAM-1 and NKp30. Exp Hematol 2009; 37:1167-75. [PMID: 19580844 DOI: 10.1016/j.exphem.2009.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 06/25/2009] [Accepted: 06/29/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Natural killer (NK) cells and dendritic cells (DC) can give rise to reciprocal functional interactions resulting in promotion of DC maturation, killing of immature DC (iDC), and proliferation of NK cells. In this study, we analyze whether, in NK-lymphoproliferative disease of granular lymphocytes (LDGL) patients, this function could be altered and contribute to the persistence of the disease. MATERIALS AND METHODS Freshly isolated peripheral blood NK granular lymphocytes (GL) and NK cell lines derived from 13 different NK-LDGL patients were analyzed in coculture experiments to evaluate their ability to interact with monocyte-derived DCs (Mo-DC). RESULTS As compared to NK cells isolated from healthy donors, NK-GLs displayed, in most cases, a reduced capability of promoting Mo-DC maturation and of killing iDC. These findings could be explained, at least in part, by the low expression levels of NKp30: an activating receptor involved in the molecular interactions occurring between NK cells and DC. We also show that, in the presence of DC-derived cytokines such as interleukin-12, in both patients and healthy individuals, DNAM-1 can cooperate with NKp30 to induce NK cells to kill DC, release tumor necrosis factor-alpha, and promote DC maturation. This contribution, however, is not sufficient to compensate for the defect in patients' NK cells. CONCLUSION Besides expanding knowledge of the molecular basis of the NK/DC cross-talk, our study demonstrates that NK cells from NK-LDGL patients are impaired in their ability to interact with Mo-DC. The possible relationship between such abnormal NK cell/DC interactions and chronic NK cell proliferation are discussed.
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Affiliation(s)
- Mirna Balsamo
- DI.ME.S. Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy
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45
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Shah A, Diehl LF, St Clair EW. T cell large granular lymphocyte leukemia associated with rheumatoid arthritis and neutropenia. Clin Immunol 2009; 132:145-52. [PMID: 19394280 DOI: 10.1016/j.clim.2009.03.515] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 03/15/2009] [Indexed: 12/22/2022]
Abstract
T cell large granular lymphocyte leukemia (T-LGL) is a disease characterized by clonal expansion of cytotoxic T cells (CTLs). It generally follows an indolent course and is notable for an association with chronic inflammation, neutropenia and rheumatoid arthritis (RA). We present herein a case of a patient with rheumatoid arthritis (RA), neutropenia, large granular lymphocytosis, and an expanded clonal population of peripheral blood CD3(+)CD8(+)TCRalphabeta CTLs, consistent with the diagnosis of T-LGL. T-LGL is part of a spectrum of large granular lymphocytic (LGL) disorders, which includes the more common indolent variety of this disease (as illustrated by the case herein), an aggressive but rare form of this leukemia, natural killer (NK) cell LGL leukemia, Felty's syndrome (FS), and chronic large granular lymphocytosis. T-LGL appears to be a relatively rare disease, but the true prevalence is not known. FS occurs in less than 1% of patients with RA and is typically defined by the triad of destructive arthritis, neutropenia, and variable splenomegaly. A subset of patients with FS will demonstrate polyclonal expansion of LGLs, implying a relationship between proliferation of LGLs and the mechanisms of neutropenia. Thus, T-LGL leukemia and FS with LGL expansion in the setting of RA is classically distinguished by the clonality of the CTL population, with monoclonality in T-LGL and polyclonality in FS. Despite this difference, T-LGL and FS are often similar in their clinical and biological behavior. Both may respond to immunosuppressive therapy, and pursue a smoldering course typical of a chronic inflammatory disease.
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Affiliation(s)
- Ankoor Shah
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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Chen X, Bai F, Sokol L, Zhou J, Ren A, Painter JS, Liu J, Sallman DA, Chen YA, Yoder JA, Djeu JY, Loughran TP, Epling-Burnette PK, Wei S. A critical role for DAP10 and DAP12 in CD8+ T cell-mediated tissue damage in large granular lymphocyte leukemia. Blood 2009; 113:3226-34. [PMID: 19075187 PMCID: PMC2665892 DOI: 10.1182/blood-2008-07-168245] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 11/23/2008] [Indexed: 01/02/2023] Open
Abstract
Large granular lymphocyte (LGL) leukemia, or LGLL, is characterized by increased numbers of circulating clonal LGL cells in association with neutropenia, anemia, rheumatoid arthritis, and pulmonary artery hypertension (PAH). Emerging evidence suggests that LGLL cells with a CD8(+)CD28(null) phenotype induce these clinical manifestations through direct destruction of normal tissue. Compared with CD8(+)CD28(null) T cells from healthy controls, CD8(+)CD28(null) T cells from LGLL patients have acquired the ability to directly lyse pulmonary artery endothelial cells and human synovial cells. Here, we show that LGLL cells from patients possess enhanced cytotoxic characteristics and express elevated levels of activating natural killer receptors as well as their signaling partners, DAP10 and DAP12. Moreover, downstream targets of DAP10 and DAP12 are constitutively activated in LGLL cells, and expression of dominant-negative DAP10 and DAP12 dramatically reduces their lytic capacity. These are the first results to show that activating NKR-ligand interactions play a critical role in initiating the DAP10 and DAP12 signaling events that lead to enhanced lytic potential of LGLL cells. Results shown suggest that inhibitors of DAP10 and DAP12 or other proteins involved in this signaling pathway will be attractive therapeutic targets for the treatment of LGLL and other autoimmune diseases and syndromes.
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MESH Headings
- Adaptor Proteins, Signal Transducing/genetics
- Adaptor Proteins, Signal Transducing/metabolism
- Adaptor Proteins, Signal Transducing/physiology
- CD28 Antigens/metabolism
- CD8-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/metabolism
- CD8-Positive T-Lymphocytes/pathology
- Cytotoxicity, Immunologic/genetics
- Endothelial Cells/immunology
- Endothelial Cells/pathology
- Extracellular Signal-Regulated MAP Kinases/metabolism
- Humans
- K562 Cells
- Leukemia, Large Granular Lymphocytic/genetics
- Leukemia, Large Granular Lymphocytic/immunology
- Leukemia, Large Granular Lymphocytic/metabolism
- Leukemia, Large Granular Lymphocytic/pathology
- Membrane Proteins/genetics
- Membrane Proteins/metabolism
- Membrane Proteins/physiology
- Phosphatidylinositol 3-Kinases/metabolism
- Pulmonary Artery/immunology
- Pulmonary Artery/pathology
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Receptors, Immunologic/physiology
- Receptors, Natural Killer Cell/metabolism
- Signal Transduction/genetics
- Tumor Cells, Cultured
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Affiliation(s)
- Xianghong Chen
- Immunology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, 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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Subbiah V, Viny AD, Rosenblatt S, Pohlman B, Lichtin A, Maciejewski JP. Outcomes of splenectomy in T-cell large granular lymphocyte leukemia with splenomegaly and cytopenia. Exp Hematol 2008; 36:1078-83. [PMID: 18550263 DOI: 10.1016/j.exphem.2008.04.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 04/01/2008] [Accepted: 04/08/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE T-cell large granular lymphocyte leukemia (T-LGL) is a chronic clonal lymphoproliferation of cytotoxic T cells often complicated by cytopenia. Because the outcomes of splenectomy in patients with T-LGL have been only reported sporadically, we objectively assessed the outcomes of splenectomy. MATERIALS AND METHODS When a cohort of 56 T-LGL patients was analyzed, patients with splenomegaly (n = 34) and had higher frequency of bi- and pancytopenia than patients with no splenomegaly (70% vs 27%; p = 0.001). We identified 15 patients who, in their clinical course, underwent splenectomy and studied their hematological and clinical outcomes. RESULTS Indications for splenectomy included symptomatic splenomegaly and/or severe refractory cytopenia. Median spleen weight was 1300 g, consistent with diagnosis of splenomegaly; T-cell receptor (TCR)-gamma rearrangement and typical T-LGL were detected by immunophenotype in all specimens. There was no surgery-related mortality, with the median follow-up and survival of 719 and 498 days, respectively. Two patients died due to causes possibly related to the splenectomized state and/or primary disease. All patients showed lineage-specific hematologic response and achieved transfusion independence; however, precise molecular analysis of TCR and variable chain Vbeta flow cytometry showed persistence of the LGL clones. CONCLUSION We conclude that splenectomy constitutes a viable and safe therapeutic option for patients with T-LGL, splenomegaly, and refractory cytopenia.
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Affiliation(s)
- Vivek Subbiah
- Experimental Hematology and Hematopoiesis Section, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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