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Gadgeel M, Al Kooheji I, Al-Qanber B, Buck S, Savaşan S. T-large granular lymphocyte frequencies and correlates in disease states detected by multiparameter flow cytometry in pediatric and young adult population. Ann Hematol 2024; 103:133-140. [PMID: 37731148 DOI: 10.1007/s00277-023-05449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
T-large granular lymphocytes (T-LGL) characterized by dim CD5 staining, although not completely understood, have unique roles in the immune system. Expansion of peripheral blood (PB) clonal T-LGL populations is associated with various entities in adults. We have previously demonstrated clonal T-LGL proliferations in pediatric immune dysregulation/inflammatory/proliferative conditions. However, T-LGL populations have not been studied in broader spectrum pathologies. In this study we evaluated sizes and correlates of T-LGL populations in the pediatric and young adult populations with various disease states. Lymphocytes including T-LGL were investigated retrospectively by reviewing PB multiparameter flow cytometric data with various indications over a 4-year period. Associations with clinical, laboratory findings, and T-LGL population sizes were sought. Among 520 cases reviewed, 240 were females and 280 males with a mean age of 9 years (0-33 years); mean T-LGL population constituted 14% (1-67%) in PB T cells. There were significant differences between T-LGL and CD5-bright, regular T cells. T-LGL correlated with CD8 + /DR + (R = 0.570; P < 0.01) and CD8 + /CD11b + (R = 0.597; P < 0.01) expression, indicating activated cytotoxic phenotype. The highest average T-LGL were seen in bone marrow transplant recipients (23.7%), Evans syndrome (23.7%), lymphoma (20.6%), and acute EBV infection (20.4%) cases, all with underlying immune dysregulation pathologies. In pediatric and young adult patients with different clinical conditions, PB T-LGL constitute an average of 14% of the T cells and have a predominantly activated cytotoxic T cell phenotype. Higher relative presence was seen in cases with an immune dysregulation background. These results may serve as a reference for T-LGL research efforts.
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Affiliation(s)
- Manisha Gadgeel
- Hematology/Oncology Flow Cytometry Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Pleasant, USA
| | - Ishaq Al Kooheji
- Hematology/Oncology Flow Cytometry Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Pleasant, USA
| | - Batool Al-Qanber
- Hematology/Oncology Flow Cytometry Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Pleasant, USA
| | - Steven Buck
- Hematology/Oncology Flow Cytometry Laboratory, Children's Hospital of Michigan, Detroit, MI, USA
| | - Süreyya Savaşan
- Hematology/Oncology Flow Cytometry Laboratory, Children's Hospital of Michigan, Detroit, MI, USA.
- Department of Pediatrics, Central Michigan University College of Medicine, Mt Pleasant, USA.
- Division of Hematology/Oncology, Pediatric Transplant and Cellular Therapy Program, Children's Hospital of Michigan, Detroit, MI, USA.
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2
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Duminuco A, Parisi M, Milone GA, Cupri A, Leotta S, Palumbo GA, Parrinello NL, Scuderi G, Triolo A, Milone G. Transient Leukemoid Reaction from T-Cell Large Granular Lymphocytes Post Autologous Stem Cell Transplant in a Patient Affected by Hodgkin Lymphoma. Hematol Rep 2023; 15:555-561. [PMID: 37873793 PMCID: PMC10594426 DOI: 10.3390/hematolrep15040058] [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: 03/23/2023] [Revised: 05/25/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Monoclonal T-cell lymphocytosis has been reported in patients with concomitant autoimmune diseases, viral infections, or immunodeficiencies. Referred to as T-cell large granular lymphocytic leukemia (T-LGLL), most cases cannot identify the triggering cause. Only small case series have been reported in the literature, and no treatment consensus exists. T-cell lymphocytosis may also appear after the transplant of hematopoietic stem cells or solid organs. Rare cases have been reported in patients undergoing autologous stem cell transplant (ASCT) for hematological diseases (including multiple myeloma or non-Hodgkin's lymphoma). Here, we describe the singular case of a patient who underwent ASCT for Hodgkin's lymphoma and displayed the onset of T-LGLL with an uncommonly high number of lymphocytes in peripheral blood and their subsequent spontaneous remission.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Marina Parisi
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Giulio Antonio Milone
- Division of Hematology with BMT, Istituto Oncologico del Mediterraneo, 95029 Viagrande, Italy;
| | - Alessandra Cupri
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Salvatore Leotta
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Giuseppe A. Palumbo
- Department of Medical, Surgical Sciences and Advanced Technologies, “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Nunziatina Laura Parrinello
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Grazia Scuderi
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Anna Triolo
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
| | - Giuseppe Milone
- Hematology Unit and Bone Marrow Transplant, A.O.U. Policlinico “G. Rodolico—San Marco”, 95123 Catania, Italy; (M.P.); (A.C.); (S.L.); (N.L.P.); (G.S.); (A.T.)
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3
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Semenzato G, Calabretto G, Barilà G, Gasparini VR, Teramo A, Zambello R. Not all LGL leukemias are created equal. Blood Rev 2023; 60:101058. [PMID: 36870881 DOI: 10.1016/j.blre.2023.101058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Large Granular Lymphocyte (LGL) Leukemia is a rare, heterogeneous even more that once thought, chronic lymphoproliferative disorder characterized by the clonal expansion of T- or NK-LGLs that requires appropriate immunophenotypic and molecular characterization. As in many other hematological conditions, genomic features are taking research efforts one step further and are also becoming instrumental in refining discrete subsets of LGL disorders. In particular, STAT3 and STAT5B mutations may be harbored in leukemic cells and their presence has been linked to diagnosis of LGL disorders. On clinical grounds, a correlation has been established in CD8+ T-LGLL patients between STAT3 mutations and clinical features, in particular neutropenia that favors the onset of severe infections. Revisiting biological aspects, clinical features as well as current and predictable emerging treatments of these disorders, we will herein discuss why appropriate dissection of different disease variants is needed to better manage patients with LGL disorders.
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Affiliation(s)
- Gianpietro Semenzato
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy.
| | - Giulia Calabretto
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy
| | - Gregorio Barilà
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy
| | - Vanessa Rebecca Gasparini
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy
| | - Antonella Teramo
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy.
| | - Renato Zambello
- University of Padova, Department of Medicine, Hematology Unit, Italy; Veneto Institute of Molecular Medicine, Padova, Italy.
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4
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Semenzato G, Ghobrial IM, Ghia P. Monoclonal B-cell lymphocytosis, monoclonal gammopathy of undetermined significance, and T-cell clones of uncertain significance: are these premalignant conditions sharing a common identity? Lancet Haematol 2023; 10:e549-e556. [PMID: 37407144 DOI: 10.1016/s2352-3026(23)00086-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 07/07/2023]
Abstract
Monoclonal B-cell lymphocytosis, monoclonal gammopathy of undetermined significance, and T-cell clones of uncertain significance are three premalignant conditions characterised by the presence of small clonal cell expansions in individuals without symptoms or signs that distinguish the related overt malignancies (chronic lymphocytic leukaemia, multiple myeloma, and T-cell large granular lymphocytic leukaemia). As most individuals with these precursor states never progress to malignancies, considerable interest has arisen in comprehending the steps involved in the progression to malignancy, providing more accurate models to investigate potential mechanisms of early blood cancer identification, prevention, and, possibly, intervention. Single-cell technologies and recent progress in high-throughput sequencing and multiomics approaches have contributed to a better definition of the pathophysiological mechanisms of these premalignant conditions, moving our knowledge in the field forward. In this Viewpoint, we analyse the seemingly shared biological trajectories in these precursor haematological malignancies in search of common pathogenetic events. In particular, we address the issue of interactions between expanding clones and their immune ecosystem, offering new clues that might prompt innovative ideas and inspire further investigations to understand the cellular and molecular dynamics entailing progression into overt malignant disease. The relationships between the non-leukaemic microenvironmental cells and the leukaemic counterpart, and the primary drivers of their initial clonal expansion, represent shared biologies that suggest a common identity among the premalignant conditions considered in this Viewpoint.
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Affiliation(s)
- Gianpietro Semenzato
- Haematology Section, Department of Medicine, University of Padova, Padua, Italy; Veneto Institute of Molecular Medicine, Padua, Italy.
| | | | - Paolo Ghia
- Vita-Salute San Raffaele University, Milan, Italy; IRCCS San Raffaele Hospital, Milan, Italy
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5
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Drillet G, Pastoret C, Moignet A, Lamy T, Marchand T. Large granular lymphocyte leukemia: An indolent clonal proliferative disease associated with an array of various immunologic disorders. Rev Med Interne 2023:S0248-8663(23)00119-4. [PMID: 37087371 DOI: 10.1016/j.revmed.2023.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/15/2023] [Accepted: 03/31/2023] [Indexed: 04/24/2023]
Abstract
Large granular lymphocyte leukemia (LGLL) is a chronic lymphoproliferative disorder characterized by the proliferation of T or NK cytotoxic cells in the peripheral blood, the spleen and the bone marrow. Neutropenia leading to recurrent infections represents the main manifestation of LGLL. One specificity of LGLL is its frequent association with auto-immune disorders, among them first and foremost rheumatoid arthritis, and other hematologic diseases, including pure red cell aplasia and bone marrow failure. The large spectrum of manifestations and the classical indolent course contribute to the diagnosis difficulties and the frequency of underdiagnosed cases. Of importance, the dysimmune manifestations disappear with the treatment of LGLL as the blood cell counts normalize, giving a strong argument for a pathological link between the two entities. The therapeutic challenge results from the high rate of relapses following the first line of immunosuppressive drugs. New targeted agents, some of which are currently approved in autoimmune diseases, appear to be relevant therapeutic strategies to treat LGLL, by targeting key activated pathways involved in the pathogenesis of the disease, including JAK-STAT signaling.
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Affiliation(s)
- G Drillet
- Service d'hématologie clinique, centre hospitalier universitaire de Rennes, Rennes, France.
| | - C Pastoret
- Laboratoire d'hématologie, centre hospitalier universitaire de Rennes, Rennes, France
| | - A Moignet
- Service d'hématologie clinique, centre hospitalier universitaire de Rennes, Rennes, France
| | - T Lamy
- Service d'hématologie clinique, centre hospitalier universitaire de Rennes, Rennes, France; Université Rennes 1, Rennes, France; CIC 1414, Rennes, France; Institut national de la santé et de la recherche médicale (INSERM) U1236, Rennes, France
| | - T Marchand
- Service d'hématologie clinique, centre hospitalier universitaire de Rennes, Rennes, France; Université Rennes 1, Rennes, France; Institut national de la santé et de la recherche médicale (INSERM) U1236, Rennes, France
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6
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Johansson P, Laguna T, Ossowski J, Pancaldi V, Brauser M, Dührsen U, Keuneke L, Queiros A, Richter J, Martín-Subero JI, Siebert R, Schlegelberger B, Küppers R, Dürig J, Murga Penas EM, Carillo-de Santa Pau E, Bergmann AK. Epigenome-wide analysis of T-cell large granular lymphocytic leukemia identifies BCL11B as a potential biomarker. Clin Epigenetics 2022; 14:148. [PMID: 36376973 PMCID: PMC9664638 DOI: 10.1186/s13148-022-01362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The molecular pathogenesis of T-cell large granular lymphocytic leukemia (T-LGLL), a mature T-cell leukemia arising commonly from T-cell receptor αβ-positive CD8+ memory cytotoxic T cells, is only partly understood. The role of deregulated methylation in T-LGLL is not well known. We analyzed the epigenetic profile of T-LGLL cells of 11 patients compared to their normal counterparts by array-based DNA methylation profiling. For identification of molecular events driving the pathogenesis of T-LGLL, we compared the differentially methylated loci between the T-LGLL cases and normal T cells with chromatin segmentation data of benign T cells from the BLUEPRINT project. Moreover, we analyzed gene expression data of T-LGLL and benign T cells and validated the results by pyrosequencing in an extended cohort of 17 patients, including five patients with sequential samples. RESULTS We identified dysregulation of DNA methylation associated with altered gene expression in T-LGLL. Since T-LGLL is a rare disease, the samples size is low. But as confirmed for each sample, hypermethylation of T-LGLL cells at various CpG sites located at enhancer regions is a hallmark of this disease. The interaction of BLC11B and C14orf64 as suggested by in silico data analysis could provide a novel pathogenetic mechanism that needs further experimental investigation. CONCLUSIONS DNA methylation is altered in T-LGLL cells compared to benign T cells. In particular, BCL11B is highly significant differentially methylated in T-LGLL cells. Although our results have to be validated in a larger patient cohort, BCL11B could be considered as a potential biomarker for this leukemia. In addition, altered gene expression and hypermethylation of enhancer regions could serve as potential mechanisms for treatment of this disease. Gene interactions of dysregulated genes, like BLC11B and C14orf64, may play an important role in pathogenic mechanisms and should be further analyzed.
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Affiliation(s)
- Patricia Johansson
- grid.5718.b0000 0001 2187 5445Faculty of Medicine, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Virchowstr. 177, 45122 Essen, Germany
| | - Teresa Laguna
- grid.482878.90000 0004 0500 5302Computational Biology Group, Precision Nutrition and Cancer Research Program, IMDEA Food Institute, 28049 Madrid, Spain
| | - Julio Ossowski
- grid.9764.c0000 0001 2153 9986Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany ,grid.10423.340000 0000 9529 9877Institute of Human Genetics, Medical School Hannover (MHH), Hannover, Germany
| | - Vera Pancaldi
- grid.468186.5Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, CNRS, Université Toulouse III-Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, INSERM U1037, 31037 Toulouse, France ,grid.10097.3f0000 0004 0387 1602Barcelona Supercomputing Center, 08034 Barcelona, Spain
| | - Martina Brauser
- grid.5718.b0000 0001 2187 5445Faculty of Medicine, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Virchowstr. 177, 45122 Essen, Germany
| | - Ulrich Dührsen
- grid.5718.b0000 0001 2187 5445Department of Hematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lara Keuneke
- grid.9764.c0000 0001 2153 9986Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Ana Queiros
- grid.5841.80000 0004 1937 0247Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Julia Richter
- grid.9764.c0000 0001 2153 9986Institute for Pathology, Christian-Albrechts-University Kiel and University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - José I. Martín-Subero
- grid.5841.80000 0004 1937 0247Institut d’Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain ,grid.425902.80000 0000 9601 989XInstitució Catalana de Recerca i Estudis Avançats (ICREA), 08010 Barcelona, Spain
| | - Reiner Siebert
- grid.9764.c0000 0001 2153 9986Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany ,grid.410712.10000 0004 0473 882XPresent Address: Institute of Human Genetics, University of Ulm and University Medical Center Ulm, Ulm, Germany
| | - Brigitte Schlegelberger
- grid.10423.340000 0000 9529 9877Institute of Human Genetics, Medical School Hannover (MHH), Hannover, Germany
| | - Ralf Küppers
- grid.5718.b0000 0001 2187 5445Faculty of Medicine, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, Virchowstr. 177, 45122 Essen, Germany
| | - Jan Dürig
- grid.500068.bDepartment of Internal Medicine, University Hospital Essen, St. Josef-Krankenhaus, University Medicine Essen, Essen, Germany
| | - Eva M. Murga Penas
- grid.9764.c0000 0001 2153 9986Institute for Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Enrique Carillo-de Santa Pau
- grid.482878.90000 0004 0500 5302Computational Biology Group, Precision Nutrition and Cancer Research Program, IMDEA Food Institute, 28049 Madrid, Spain
| | - Anke K. Bergmann
- grid.10423.340000 0000 9529 9877Institute of Human Genetics, Medical School Hannover (MHH), Hannover, Germany
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Gaudio F, Masciopinto P, Bellitti E, Musto P, Arcuti E, Battisti O, Cazzato G, Solombrino A, Laddaga FE, Specchia G, Maiorano E, Ingravallo G. Molecular Features and Diagnostic Challenges in Alpha/Beta T-Cell Large Granular Lymphocyte Leukemia. Int J Mol Sci 2022; 23:ijms232113392. [PMID: 36362180 PMCID: PMC9657804 DOI: 10.3390/ijms232113392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Large granular lymphocyte leukemia is a rare chronic lymphoproliferative disease of cytotoxic lymphocytes. The diagnosis, according to the WHO, is based on a persistent (>6 months) increase in the number of LGL cells in the peripheral blood without an identifiable cause. A further distinction is made between T-LGL and NK-LGL leukemia. The molecular sign of LGL leukemia is the mutation of STAT3 and other genes associated with the JAK/STAT pathway. The most common clinical features are neutropenia, anemia, and thrombocytopenia, and it is often associated with various autoimmune conditions. It usually has an indolent course. Due to the rarity of the disease, no specific treatment has yet been identified. Immunosuppressive therapy is used and may allow for disease control and long-term survival, but not eradication of the leukemic clone. Here, we discuss the clinical presentation, diagnostic challenges, pathophysiology, and different treatment options available for alpha/beta T-LGL leukemia, which is the most common disease (85%), in order to better understand and manage this often misunderstood disease.
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Affiliation(s)
- Francesco Gaudio
- Hematology Section, Department of Emergency and Transplantation, University of Bari Medical School, 70124 Bari, Italy
| | - Pierluigi Masciopinto
- Hematology Section, Department of Emergency and Transplantation, University of Bari Medical School, 70124 Bari, Italy
| | - Emilio Bellitti
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Pellegrino Musto
- Hematology Section, Department of Emergency and Transplantation, University of Bari Medical School, 70124 Bari, Italy
| | - Elena Arcuti
- Hematology Section, Department of Emergency and Transplantation, University of Bari Medical School, 70124 Bari, Italy
| | - Olga Battisti
- Hematology Section, Department of Emergency and Transplantation, University of Bari Medical School, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Alessandra Solombrino
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy
| | | | - Giorgina Specchia
- School of Medicine, University of Bari “Aldo Moro”, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - Eugenio Maiorano
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy
- Correspondence:
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy
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8
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Cheon H, Elghawy O, Shemo BC, Feith DJ, Loughran TP. LGL leukemia patients exhibit substantial protective humoral responses following SARS-CoV-2 vaccination. EJHAEM 2022; 3:919-923. [PMID: 35941882 PMCID: PMC9348025 DOI: 10.1002/jha2.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
Large granular lymphocyte leukemia is a rare chronic lymphoproliferative disorder of cytotoxic cells. Other hematological malignancies such as CLL and multiple myeloma have been associated with poor vaccination response and markedly increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mortality rates, specifically in patients who have undergone immunosuppressive therapy. Given the immunosuppressive therapies often used to treat the disease, large granular lymphocytic (LGL) patients may be especially vulnerable to SARS-CoV-2 infection. A questionnaire was sent to all patients in the LGL Leukemia Registry at the University of Virginia (UVA) to obtain information on vaccination status, type of vaccine received, side effects of vaccination, patient treatment status before, during, and after vaccination, antibody testing, history of coronavirus disease 2019 (COVID-19) infection, and presence or absence of booster vaccination. Antibody testing of 27 patients who had quantitative SARS-CoV-2 Spike Protein IgG levels determined by University of Virginia medical laboratories via the Abbott Architect SARS-CoV-2 IgG II assay were collected. The assay was scored as reactive at a threshold of ≥50.0 AU/mL or nonreactive with a threshold of <50.0 AU/mL. LGL patients without treatment as well as patients who held treatment prior to their vaccination have a robust humoral response to SARS-CoV-2 vaccines. Patients who did not hold their immunosuppressive treatments have signifigantly diminished vaccine response compared to those who held their immunosuppressive treatment. Our findings support a dual strategy of pausing immunotherapy during the vaccination window and administration of the SARS-CoV-2 booster to all LGL leukemia patients to maximize protective antibodies.
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Affiliation(s)
- Heejin Cheon
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - Omar Elghawy
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - Bryna C. Shemo
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
| | - David J. Feith
- University of Virginia Cancer CenterCharlottesvilleVirginiaUSA
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9
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Persistent Large Granular Lymphocyte Clonal Expansions: “The Root of Many Evils”—And of Some Goodness. Cancers (Basel) 2022; 14:cancers14051340. [PMID: 35267648 PMCID: PMC8909662 DOI: 10.3390/cancers14051340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Large granular lymphocyte leukemia (LGLL) is a chronic disorder of either mature T or NK lymphocytes. As clonal expansions of the immune system cells, difficulties in the distinction between a true neoplasia and a physiological reactive process have been common since its description. We review here the different conditions associated with persistent clonal LGL expansions and discuss their potential origin and whether they can modulate the clinical features. Abstract Large granular lymphocyte leukemia (LGLL) is a chronic disease of either mature phenotype cytotoxic CD3+ T lymphocytes or CD3- NK cells. LGLL diagnosis is hampered by the fact that reactive persistent clonal LGL expansions may fulfill the current criteria for LGLL diagnoses. In addition to the presence of characteristic clinical and hematological signs such as anemia or neutropenia, LGLL/LGL clonal expansions have been associated with an array of conditions/disorders. We review here the presence of these persistent clonal expansions in autoimmune, hematological disorders and solid neoplasms and after hematopoietic stem cell transplantation. These associations are a unique translational research framework to discern whether these persistently expanded LGL clones are causes or consequences of the concomitant clinical settings and, more importantly, when they should be targeted.
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10
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Magnano L, Rivero A, Matutes E. Large Granular Lymphocytic Leukemia: Current State of Diagnosis, Pathogenesis and Treatment. Curr Oncol Rep 2022; 24:633-644. [PMID: 35212923 DOI: 10.1007/s11912-021-01159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW This manuscript aims at updating the knowledge on the clinico-biological characteristics, pathogenesis, and the diagnostic challenges of T-LGLL and CLPD-NK disorders and reviews the advances in the management and treatment of these patients. RECENT FINDINGS It has been shown that clonal large granular lymphocyte (LGL) expansions arise from chronic antigenic stimulation, leading to resistance to apoptosis. All the above findings have facilitated the diagnosis of LGLL and provided insights in the pathogenesis of the disease. At present, there is no standard first-line therapy for the disease. Immunosuppressive agents are the treatment routinely used in clinical practice. However, these agents have a limited capacity to eradicate the LGL clone and induce long-lasting remission. Advances in the knowledge of pathogenesis have made it possible to explore new therapeutic targets with promising results. Since LGLL is a rare disease, international efforts are needed to carry on prospective clinical trials with new potentially active drugs that could include a large number of patients.
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Affiliation(s)
- Laura Magnano
- Department of Hematology, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Andrea Rivero
- Department of Hematology, Hospital Clínic, Barcelona, Spain
| | - Estella Matutes
- Hematopathology Unit, Department of Pathology, Hospital Clínic, Barcelona University, Villarroel, 170, 08036, Barcelona, Spain.
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Drillet G, Pastoret C, Moignet A, Lamy T, Marchand T. Toward a Better Classification System for NK-LGL Disorders. Front Oncol 2022; 12:821382. [PMID: 35178350 PMCID: PMC8843930 DOI: 10.3389/fonc.2022.821382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022] Open
Abstract
Large granular lymphocytic leukemia is a rare lymphoproliferative disorder characterized by a clonal expansion of T-lineage lymphocyte or natural killer (NK) cells in 85 and 15% of cases respectively. T and NK large granular leukemia share common pathophysiology, clinical and biological presentation. The disease is characterized by cytopenia and a frequent association with autoimmune manifestations. Despite an indolent course allowing a watch and wait attitude in the majority of patients at diagnosis, two third of the patient will eventually need a treatment during the course of the disease. Unlike T lymphocyte, NK cells do not express T cell receptor making the proof of clonality difficult. Indeed, the distinction between clonal and reactive NK-cell expansion observed in several situations such as autoimmune diseases and viral infections is challenging. Advances in our understanding of the pathogenesis with the recent identification of recurrent mutations provide new tools to prove the clonality. In this review, we will discuss the pathophysiology of NK large granular leukemia, the recent advances in the diagnosis and therapeutic strategies.
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Affiliation(s)
- Gaëlle Drillet
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Cédric Pastoret
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Aline Moignet
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Thierry Lamy
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France.,CIC 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1236, Rennes, France
| | - Tony Marchand
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Faculté de Médecine, Université Rennes 1, Rennes, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U1236, Rennes, France
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12
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Xu Q, Yu J, Lin X, Li Y, Zhang K. CB-LPD, MGUS, T-LGLL, and PRCA: A rare case report of 4 concomitant hematological disorders. Medicine (Baltimore) 2021; 100:e27874. [PMID: 34964755 PMCID: PMC8615434 DOI: 10.1097/md.0000000000027874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic clonal plasma cell or lymphoplasmacytic proliferative disorder. Recently, some case reports have described the association of pure red cell aplasia (PRCA) with MGUS, even with a relatively low monoclonal immunoglobulin burden. T large granular lymphocyte leukemia (T-LGLL) is a chronic lymphoproliferative disorder characterized by clonal expansion of T large granular lymphocytes, which is rare in China. There are some reports about T-LGL leukemia in patients with B-cell lymphoma; however, it is very rare that T-LGLL coexists with MGUS and clonal B-cell lymphoproliferative disorders (CB-LPD). PATIENT CONCERNS A 77-year-old man was hospitalized because of anemia. He was diagnosed with MGUS, CB-LPD, and PRCA. During the development of the disease, a group of abnormal T lymphocytes was detected by flow cytometry of peripheral blood. DIAGNOSIS Combining clinical manifestations with the result of T cell receptor gene rearrangement and immunophenotype, it was consistent with the diagnosis of T large granular lymphocyte leukemia. INTERVENTIONS The patient was treat with bortezomib and dexamethasone regimen, Rituximab and sirolimus. OUTCOMES The patient was transfusion independent after therapies. LESSONS We report a patient with 4 concomitant hematological disorders: T-LGLL, MGUS, CB-LPD, and PRCA, aiming to represent the clinical and flow cytometry characteristics of these concomitant diseases, analyze the mechanism between diseases, and provide a clinical reference.
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Affiliation(s)
- Qinhong Xu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Jieni Yu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Xiaoyan Lin
- The Center of Clinical Laboratory, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Youli Li
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Kejie Zhang
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
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Gorodetskiy VR, Probatova NA, Kupryshina NA, Palshina SG, Obukhova TN, Sidorova YV, Ryzhikova NV, Sudarikov AB. Simultaneous Presentation of Leukemic Non-Nodal Mantle Cell Lymphoma and Gamma-Delta T-Large Granular Lymphocytic Leukemia in a Patient with Rheumatoid Arthritis. Cancer Manag Res 2020; 12:9449-9457. [PMID: 33061632 PMCID: PMC7533220 DOI: 10.2147/cmar.s261910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022] Open
Abstract
The peculiar features of T-cell large granular lymphocytic leukemia (T-LGLL) are its association with autoimmune disorders (particularly with rheumatoid arthritis (RA)) and a broad spectrum of B-cell lymphoproliferative disorders. However, association of T-LGLL with mantle cell lymphoma (MCL) is extremely rare. Here, we describe a case of an 80-year-old man admitted with suspected Felty’s syndrome. The blood count showed white blood cells at 2.2×109/L, with 3% neutrophils, 88% lymphocytes, and at 0.66×109/L LGLs. The spleen had been removed 43 months prior to the admission due to suspected B-cell splenic lymphoma. Re-examination of the spleen revealed cyclin D1+ and SOX11− lymphocytes in the inner part of the unexpanded mantle zones of the white pulp follicles, thus displaying a so-called in situ histologic pattern of MCL, and in small clusters in the red pulp. The splenic cords were moderately expanded by lymphocytes expressing CD3, TIA1, and granzyme B but not CD4 and CD8. Monoclonal rearrangements of the immunoglobulin heavy chain gene and the T-cell receptor (TCR) gamma and delta chain genes, polyclonal rearrangements of the TCR beta chain gene, mutation of the signal transducer and activator of transctiption 3 gene (c.1940A>T; p.N647I), and t(11;14)(q13;q32) translocation were identified in the spleen sample. Flow cytometry of bone marrow revealed a population of TCR γδ+, CD3+, CD4−, CD5−, CD7+, CD8−, CD16−, CD56−, and CD57− lymphocytes. Fragment analysis demonstrated identical TCR gene clonal rearrangement patterns in the spleen and bone marrow samples. In this study, we describe the first case of simultaneous presentation of γδ T-LGLL and leukemic non-nodal MCL (L-NN-MCL) in a patient with RA and present morphological findings of L-NN-MCL in the spleen.
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Affiliation(s)
- Vadim R Gorodetskiy
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Natalya A Probatova
- Department of Pathology, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Natalia A Kupryshina
- Hematopoiesis Immunology Laboratory, N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Svetlana G Palshina
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Tatiana N Obukhova
- Cytogenetic Laboratory, National Research Center for Hematology, Moscow, Russia
| | - Yulia V Sidorova
- Laboratory of Molecular Hematology, National Research Center for Hematology, Moscow, Russia
| | - Natalya V Ryzhikova
- Laboratory of Molecular Hematology, National Research Center for Hematology, Moscow, Russia
| | - Andrey B Sudarikov
- Laboratory of Molecular Hematology, National Research Center for Hematology, Moscow, Russia
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T-Cell Large Granular Lymphocytic Leukemia with Extremely Rare Immunophenotype (CD4/CD8 Double-Positive) Followed by Multiple Myeloma Diagnosis. Case Rep Hematol 2020; 2020:8839144. [PMID: 32855829 PMCID: PMC7443251 DOI: 10.1155/2020/8839144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/18/2020] [Accepted: 07/29/2020] [Indexed: 12/31/2022] Open
Abstract
T-cell large granular lymphocytic leukemia is characterized by clonal expansion of a CD3+/CD57+ subpopulation, which are typically CD8+ positive cytotoxic T- cells, and can only be diagnosed if there is a persistent, greater than 6 months, elevation of LGL in the blood (usually 2–20 × 109/L), in the absence of an identifiable cause. T-LGLL has been associated with reactive conditions such as autoimmune diseases and viral infections and has also been reported in association with hematologic and non-hematologic malignancies. We report a case of asymptomatic CD4/CD8 double-positive T-LGLL. Flow cytometry on peripheral blood revealed a subpopulation of CD4/CD8 double-positive T cells expressing CD57 and cTIA. Clonality was established by flow cytometric analysis of T-cell receptor V(â) region repertoire which showed that >70% of the cells failed to express any of the tested V(â) regions. Clonality was further confirmed by PCR with the detection of clonal TCR beta and TCR gamma gene rearrangements. Six months later, she presented with persistent lower back pain and diagnosed with IgG kappa multiple myeloma. CD4/CD8 double-positive T-large granular leukemia is the first case reported in the literature. This rare phenotype is either underreported or a truly rare clinical entity. More studies are warranted to characterize the pathogenesis and clinical characteristics of this group of patients and to further assess the relationship between multiple myeloma and T-LGLL as a cause-and-effect relationship or simply related to the time at which diagnosis has been made.
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Cheon H, Dziewulska KH, Moosic KB, Olson KC, Gru AA, Feith DJ, Loughran TP. Advances in the Diagnosis and Treatment of Large Granular Lymphocytic Leukemia. Curr Hematol Malig Rep 2020; 15:103-112. [PMID: 32062772 PMCID: PMC7234906 DOI: 10.1007/s11899-020-00565-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The past decade in LGL leukemia research has seen increased pairing of clinical data with molecular markers, shedding new insights on LGL leukemia pathogenesis and heterogeneity. This review summarizes the current standard of care of LGL leukemia, updates from clinical trials, and our congruent improved understanding of LGL pathogenesis. RECENT FINDINGS Various clinical reports have identified associations between stem, bone marrow, and solid organ transplants and incidence of LGL leukemia. There is also a potential for underdiagnosis of LGL leukemia within the rheumatoid arthritis patient population, emphasizing our need for continued study. Preliminary results from the BNZ-1 clinical trial, which targets IL-15 along with IL-2 and IL-9 signaling pathways, show some evidence of clinical response. With advances in our understanding of LGL pathogenesis from both the bench and the clinic, exciting avenues for investigations lie ahead for LGL leukemia.
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Affiliation(s)
- HeeJin Cheon
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA
- Department of Biochemistry and Molecular Genetics, Charlottesville, VA, 22908, USA
- Medical Scientist Training Program, Charlottesville, VA, 22908, USA
| | - Karolina H Dziewulska
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Katharine B Moosic
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Kristine C Olson
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - David J Feith
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA
| | - Thomas P Loughran
- Department of Medicine, Division of Hematology & Oncology, University of Virginia Cancer Center, PO Box 800334, Charlottesville, VA, 22908-0334, USA.
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16
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Durrani J, Awada H, Kishtagari A, Visconte V, Kerr C, Adema V, Nagata Y, Kuzmanovic T, Hong S, Patel B, Nazha A, Lichtin A, Mukherjee S, Saunthararajah Y, Carraway H, Sekeres M, Maciejewski JP. Large granular lymphocytic leukemia coexists with myeloid clones and myelodysplastic syndrome. Leukemia 2020; 34:957-962. [PMID: 31624375 PMCID: PMC8370475 DOI: 10.1038/s41375-019-0601-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 08/27/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Jibran Durrani
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hassan Awada
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashwin Kishtagari
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Cassandra Kerr
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vera Adema
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasunobu Nagata
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Teodora Kuzmanovic
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sanghee Hong
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bhumika Patel
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aziz Nazha
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan Lichtin
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudipto Mukherjee
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yogen Saunthararajah
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hetty Carraway
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mikkael Sekeres
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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17
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Autoimmune Complications in Chronic Lymphocytic Leukemia in the Era of Targeted Drugs. Cancers (Basel) 2020; 12:cancers12020282. [PMID: 31979293 PMCID: PMC7072470 DOI: 10.3390/cancers12020282] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/21/2022] Open
Abstract
Autoimmune phenomena are frequently observed in patients with chronic lymphocytic leukemia (CLL) and are mainly attributable to underlying dysfunctions of the immune system. Autoimmune cytopenias (AIC) affect 4-7% of patients with CLL and mainly consist of autoimmune hemolytic anemia and immune thrombocytopenia. Although less common, non-hematological autoimmune manifestations have also been reported. Treatment of CLL associated AIC should be primarily directed against the autoimmune phenomenon, and CLL specific therapy should be reserved to refractory cases or patients with additional signs of disease progression. New targeted drugs (ibrutinib, idelalisib and venetoclax) recently entered the therapeutic armamentarium of CLL, showing excellent results in terms of efficacy and became an alternative option to standard chemo-immunotherapy for the management of CLL associated AIC. However, the possible role of these drugs in inducing or exacerbating autoimmune phenomena still needs to be elucidated. In this article, we review currently available data concerning autoimmune phenomena in patients with CLL, particularly focusing on patients treated with ibrutinib, idelalisib, or venetoclax, and we discuss the possible role of these agents in the management of AIC.
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18
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Awada H, Mahfouz RZ, Durrani J, Kishtagari A, Jagadeesh D, Lichtin AE, Hill BT, Hamilton BK, Carraway HE, Nazha A, Majhail NS, Sobecks R, Visconte V, Kalaycio M, Sekeres MA, Maciejewski JP. Large granular lymphocytic leukaemia after solid organ and haematopoietic stem cell transplantation. Br J Haematol 2020; 189:318-322. [PMID: 31958160 DOI: 10.1111/bjh.16336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 01/07/2023]
Abstract
T-cell large granular lymphocytic leukaemia (T-LGLL) is a chronic clonal lymphoproliferative disorder of cytotoxic T lymphocytes which commonly occurs in older patients and is often associated with autoimmune diseases. Among 246 patients with T-LGLL seen at our institution over the last 10 years, we encountered 15 cases following solid organ or haematopoietic stem cell transplantation. Here, we studied the clinical characterization of these cases and compared them to de novo T-LGLL. This experience represented a clear picture of the intricate nature of the disease manifestation and the complexities of several immune mechanisms triggering the clonal expansion.
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Affiliation(s)
- Hassan Awada
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Reda Z Mahfouz
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jibran Durrani
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashwin Kishtagari
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Jagadeesh
- Lymphoid Malignancies Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan E Lichtin
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian T Hill
- Lymphoid Malignancies Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hetty E Carraway
- Leukaemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aziz Nazha
- Leukaemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Navneet S Majhail
- Blood and Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matt Kalaycio
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mikkael A Sekeres
- Leukaemia Program, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaroslaw P Maciejewski
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Mature T-cell and NK-cell leukemias represent a clinically heterogeneous group of diseases, ranging from indolent expansions of large granular lymphocytes, to aggressive diseases that are associated with a fulminant clinical course. Recent advances in genomic methodologies have massively increased the understanding of the pathogenesis of this group of diseases. While the entities are genetically heterogeneous, JAK-STAT pathway activation appears to be important across these disorders. The identification of constitutively activated pathways and the emergence of novel targeted pharmaceutical agents raise the expectation that more effective therapies will be identified for these disorders in the coming years.
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Affiliation(s)
| | - Kojo S J Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19102, United States.
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20
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Zhang M, Guan N, Zhu P, Chen T, Liu S, Hao C, Xue J. Recurrent anti-GBM disease with T-cell large granular lymphocytic leukemia: A case report. Medicine (Baltimore) 2019; 98:e16649. [PMID: 31374037 PMCID: PMC6708844 DOI: 10.1097/md.0000000000016649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Anti-glomerular basement membrane disease (anti-GBM disease) is a rare small vessel vasculitis caused by autoantibodies directed against the glomerular and alveolar basement membranes. Anti-GBM disease is usually a monophasic illness and relapse is rare after effective treatment. This article reports a case of coexistence of recurrent anti-GBM disease and T-cell large granular lymphocytic (T-LGL) leukemia. PATIENT CONCERNS A 37-year-old man presented with hematuria, edema, and acute kidney injury for 2 months. DIAGNOSIS Anti-GBM disease was diagnosed by renal biopsy, in which crescentic glomerulonephritis was observed with light microscopy, strong linear immunofluorescent staining for immunoglobulin G on the GBM and positive serum anti-GBM antibody. Given this diagnosis, the patient was treated with plasmapheresis, steroids, and cyclophosphamide for 4 months. The anti-GBM antibody titer was maintained to negative level but the patient remained dialysis-dependent. One year later, the patient suffered with a relapse of anti-GBM disease, after an extensive examination, he was further diagnosed T-LGL leukemia by accident. INTERVENTIONS The patient received cyclosporine A therapy for T-LGL leukemia. OUTCOMES After treatment with cyclosporine A, serum anti-GBM antibody became undetectable. During the 16 months follow-up, anti-GBM titer remained normal and abnormal T-lymphocytes in the bone marrow and peripheral blood were also decreased. LESSONS T-LGL leukemia is an indolent lymphoproliferative disorder that represents a monoclonal expansion of cytotoxic T cells, which has been reported to be accompanied by some autoimmune diseases. This is the first report of coincidence of T-LGL leukemia and anti-GBM disease, and suggests there are some relationships between these 2 diseases. Clinical physicians should exclude hematological tumors when faced with recurrent anti-GBM disease.
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Affiliation(s)
| | | | - Ping Zhu
- Division of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tong Chen
- Division of Hematology, Huashan Hospital, Fudan University, Shanghai, China
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21
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Moignet A, Lamy T. Latest Advances in the Diagnosis and Treatment of Large Granular Lymphocytic Leukemia. Am Soc Clin Oncol Educ Book 2018; 38:616-625. [PMID: 30231346 DOI: 10.1200/edbk_200689] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Large granular lymphocyte (LGL) leukemia has been recognized in the World Health Organization classifications among mature T cell and natural killer cell neoplasms and is divided into three categories. Chronic T cell leukemia and natural killer cell lymphocytosis can be considered as a similar spectrum of an indolent disease characterized by cytopenias and autoimmune conditions. The last category, aggressive natural killer cell LGL leukemia is very rare, related to Epstein-Barr virus, and seen mainly in young Asian people. Clonal LGL expansion arises from chronic antigenic stimulation sustained by interleukin-15 and platelet-derived growth factor cytokine signal. Those leukemic cells are resistant to apoptosis, mainly because of constitutive activation of survival pathways including Jak/Stat, MapK, Pi3k-Akt, RasRaf-1, MEK1/ERK, sphingolipid, and NFκB. Stat3 constitutive activation is the hallmark of this lymphoproliferative disorder. Socs3 is downregulated, but no mutation could be found to explain this status. However, several somatic mutations, including Stat3, Stat5b, and tumor necrosis factor alpha-induced protein 3, have been demonstrated recently in LGL leukemia; they are identified in half of patients and cannot explain by themselves LGL leukemogenesis. Recurrent infections as a result of chronic neutropenia, anemia, and autoimmune disorders are the main complications related to LGL leukemia. Despite an indolent presentation, 10% of patients die, mainly because of infectious complications. Current treatments are based on immunosuppressive therapies. A better mechanistic understanding of LGL leukemia will allow future consideration of a personalized therapeutic approach perhaps based on Jak/Stat inhibitors, which may offer better results than current immunosuppressive therapy.
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Affiliation(s)
- Aline Moignet
- From the Department of Hematology, Pontchaillou University Hospital, Rennes, France; and INSERM U1414-CIC, Rennes 1 University, Rennes, France
| | - Thierry Lamy
- From the Department of Hematology, Pontchaillou University Hospital, Rennes, France; and INSERM U1414-CIC, Rennes 1 University, Rennes, France
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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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23
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Sidiqi MH, Aljama MA, Viswanatha DS, Dingli D. T-cell large granular lymphocytic leukemia and plasma cell disorders. Haematologica 2018; 104:e108-e110. [PMID: 30237273 DOI: 10.3324/haematol.2018.204099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
| | | | - David S Viswanatha
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, USA
| | - David Dingli
- Division of Hematology, Department of Internal Medicine
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Clonal T-cell Large Granular Lymphocytic Disorders Manifesting in Patients with HIV-1 Infection: Case Series and Review of the Literature. Mediterr J Hematol Infect Dis 2018; 10:e2018036. [PMID: 30002792 PMCID: PMC6039084 DOI: 10.4084/mjhid.2018.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
We report five patients with human immunodeficiency virus-1/acquired immunodeficiency syndrome (HIV-1/AIDS) who developed T-cell large granular lymphocytic proliferation (T-LGLP) or leukemia (T-LGLL). None of the patients fulfilled criteria for diagnosis of diffuse infiltrative lymphocyte syndrome (DILS) or HIV-associated CD8+ lymphocytosis syndrome at the time of diagnosis of LGL. The immunophenotype of malignant T-cells was identical in three patients with co-expression of CD3, CD8, CD57, and T-cell receptor (TCR) alpha/beta. Three out of five patients were also diagnosed with clonal disorders of B-cell origin including diffuse large B-cell lymphoma, Burkitt’s lymphoma, and monoclonal gammopathy of undetermined significance (MGUS). Two patients developed cytopenias due to T-LGLL prompting initiation of therapy. Our study suggests that chronic viral infection with HIV can contribute to the evolution of T-LGLP. Clinical and laboratory characteristics of T-LGLP associated with HIV-1/AIDS resemble those of immunocompetent patients.
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Lozano C, Brun S, Arnaud A, Gaulard P, Gonzalez S, Crouzet J, Gris JC. Complete remission of agranulocytosis after splenectomy in a variant form of T-cell large granular lymphocyte leukemia. Leuk Lymphoma 2018; 60:254-257. [PMID: 29963929 DOI: 10.1080/10428194.2018.1471601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Claire Lozano
- a Department of Immunology , Montpellier University Hospital , Montpellier , France
| | - Sophie Brun
- b Department of Hematology , Nimes University Hospital , Nimes , France
| | - Anne Arnaud
- b Department of Hematology , Nimes University Hospital , Nimes , France
| | - Philippe Gaulard
- c Department of Pathological Anatomy and Cytology , AP-HP, Henri Mondor University Hospital , Creteil , France
| | - Samia Gonzalez
- d Department of Pathological Anatomy and Cytology , Nimes University Hospital , Nimes , France
| | - Julien Crouzet
- e Department of Hepatology and Gastroenterology , Hospital of Bagnols sur Ceze , Bagnols sur Ceze , France
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Wang HW, Raffeld M. Molecular assessment of clonality in lymphoid neoplasms. Semin Hematol 2018; 56:37-45. [PMID: 30573043 DOI: 10.1053/j.seminhematol.2018.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 02/03/2023]
Abstract
Molecular clonality assays in B- and T-cell lymphoproliferative disorders often provide critical information in establishing a diagnosis of a lymphoproliferative disorder. These assays rely on the unique genetic structures that serve as assay targets, created in the process of generating immunoglobulin and T-cell receptors during B- and T-cell development. Molecular clonality assays are generally used when flow cytometry or immunohistochemistry has not sufficiently clarified the benign or malignant nature of a lymphoid proliferation. Additionally, since molecular clonality assays are tumor specific, they allow the clinician to distinguish recurrences from second tumors, and have the sensitivity to monitor minimal residual disease. In this review, we discuss the principles underlying these tests, the current approaches to clonality testing, some of the pitfalls in their interpretation, and the future applications of next generation sequencing technology to clonality testing.
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Affiliation(s)
- Hao-Wei Wang
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mark Raffeld
- Molecular Diagnostics Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD.
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27
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Goyal T, Thakral B, Wang SA, Bueso-Ramos CE, Shi M, Jevremovic D, Morice WG, Zhang QY, George TI, Foucar KK, Bhattacharyya S, Bagg A, Rogers HJ, Bodo J, Durkin L, Hsi ED. T-Cell Large Granular Lymphocytic Leukemia and Coexisting B-Cell Lymphomas: A Study From the Bone Marrow Pathology Group. Am J Clin Pathol 2018; 149:164-171. [PMID: 29365010 DOI: 10.1093/ajcp/aqx146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE T-cell large granular lymphocytic (T-LGL) leukemia is associated with B-cell lymphomas (BCLs), especially small BCLs. We aimed to explore and expand upon its association with BCLs. METHODS We retrospectively studied clinicopathologic features of T-LGL leukemia patients with coexisting BCL from January 2001 to December 2016. RESULTS Among 432 patients with T-LGL leukemia, 22 (5.1%) had an associated B-cell non-Hodgkin lymphoma. Thirteen (59%) patients had large and nine (41%) had small BCL. T-LGL leukemia occurred synchronously with BCL in five, preceded BCL in three, and followed BCL in 14 patients. Anemia was the most common cytopenia (68%). Only one patient had a history of rheumatoid arthritis. CONCLUSION To our knowledge, this is the first multicenter study looking at the spectrum and incidence of BCLs in patients with T-LGL leukemia and highlights its association with large BCLs (3% of T-LGL leukemias).
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Affiliation(s)
| | | | - Sa A Wang
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Adam Bagg
- Hospital of the University of Pennsylvania, Philadelphia
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28
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Gazitt T, Loughran TP. Chronic neutropenia in LGL leukemia and rheumatoid arthritis. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:181-186. [PMID: 29222254 PMCID: PMC6142558 DOI: 10.1182/asheducation-2017.1.181] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This section reviews the diagnostic criteria and pathogenesis of large granular lymphocyte (LGL) leukemia. There is a particular focus on the overlap of LGL leukemia and rheumatoid arthritis (Felty's syndrome). Current understanding of the mechanisms of neutropenia in these disorders is discussed. Finally, treatment indications and therapeutic recommendations are outlined.
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Affiliation(s)
- Tal Gazitt
- University of Washington, Seattle, WA; and
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29
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Sanikommu SR, Clemente MJ, Chomczynski P, Afable MG, Jerez A, Thota S, Patel B, Hirsch C, Nazha A, Desamito J, Lichtin A, Pohlman B, Sekeres MA, Radivoyevitch T, Maciejewski JP. Clinical features and treatment outcomes in large granular lymphocytic leukemia (LGLL). Leuk Lymphoma 2017. [PMID: 28633612 DOI: 10.1080/10428194.2017.1339880] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Large granular lymphocytic leukemia (LGLL) represents a clonal/oligoclonal lymphoproliferation of cytotoxic T and natural killer cells often associated with STAT3 mutations. When symptomatic, due to mostly anemia and neutropenia, therapy choices are often empirically-based, because only few clinical trials and systematic studies have been performed. Incorporating new molecular and flow cytometry parameters, we identified 204 patients fulfilling uniform criteria for LGLL diagnoses and analyzed clinical course with median follow-up of 36 months, including responses to treatments. While selection of initial treatment was dictated by clinical features, the initial responses, as well as overall responses to methotrexate (MTX), cyclosporine (CsA), and cyclophosphamide (CTX), were similar at 40-50% across drugs. Sequential use of these drugs resulted in responses in most cases: only 10-20% required salvage therapies such as ATG, Campath, tofacitinib, splenectomy or abatacept. MTX yielded the most durable responses. STAT3-mutated patients required therapy more frequently and had better overall survival.
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Affiliation(s)
- Srinivasa R Sanikommu
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Michael J Clemente
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Peter Chomczynski
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Manuel G Afable
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Andres Jerez
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Swapna Thota
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Bhumika Patel
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Cassandra Hirsch
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Aziz Nazha
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - John Desamito
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Alan Lichtin
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Brad Pohlman
- b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Mikkael A Sekeres
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA.,b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
| | - Tomas Radivoyevitch
- c Department of Quantitative Health Sciences , Cleveland Clinic , Cleveland , OH , USA
| | - Jaroslaw P Maciejewski
- a Department of Translational Hematology and Oncology Research , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA.,b Department of Hematologic Oncology and Blood Disorders , Taussig Cancer Institute, Cleveland Clinic , Cleveland , OH , USA
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Atherton MJ, Vazquez-Sanmartin S, Sharpe S, Waugh EM, Morris JS. A metastatic secretory gastric plasmacytoma with aberrant CD3 expression in a dog. Vet Clin Pathol 2017; 46:520-525. [PMID: 28582596 DOI: 10.1111/vcp.12503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 10-year-old crossbred dog was presented with a 6-week history of hematemesis, melena, anorexia, and lethargy. Clinical evaluation revealed a gastric mass with a regional lymphadenomegaly as well as a monoclonal gammopathy manifesting as hyperglobulinemia. Cytologic and histopathologic analyses were consistent with a round cell neoplasm; neoplastic cells showed nuclear immunoreactivity for MUM1 and diffuse cytoplasmic reactivity for CD3. Polymerase chain reactions performed on fixed and fresh tissue identified a clonal rearrangement with an IgH primer set. An extramedullary plasmacytoma (EMP) was confirmed by cellular morphology and molecular diagnostics. Following an objective response to chemotherapy, the dog was euthanized 8 months after diagnosis, and a postmortem examination confirmed the clinical findings. This is the first reported case of a monoclonal gammopathy secondary to a gastric EMP coupled with aberrant expression of CD3 in an aggressive plasmacytic tumor, and highlights the utility of molecular diagnostics for classifying atypical hemolymphoid neoplasms.
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Affiliation(s)
- Matthew J Atherton
- Department of Pathology and Molecular Medicine, McMaster Immunology Research Centre, McMaster University, Hamilton, ON, Canada
| | | | - Sam Sharpe
- Diagnostic Services Unit, Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada
| | - Elspeth M Waugh
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Joanna S Morris
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
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31
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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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Abstract
Large granular lymphocytes (LGLs) are large lymphocytes with azurophilic granules in their cytoplasm. LGLs are either natural killer (NK) cells or T lymphocytes. Expansions of the LGLs in the peripheral blood are seen in various conditions, including three clonal disorders: T-cell LGL (T-LGL) leukemia, chronic lymphoproliferative disorders of NK cells (CLPD-NK), and aggressive NK-cell leukemia (ANKL). However, the monoclonal and polyclonal expansion of LGLs has been associated with many other conditions. The present article describes these LGL disorders, with special emphasis on the clinical features, pathogenesis, and treatments of the three above-mentioned clonal disorders.
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Affiliation(s)
- Kazuo Oshimi
- Department of Medicine, Kushiro Rosai Hospital, Japan
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Mahdi T, Rajab A, Padmore R, Porwit A. Characteristics of Lymphoproliferative Disorders with More Than One Aberrant Cell Population as Detected by 10-Color Flow Cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:230-238. [DOI: 10.1002/cyto.b.21402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/06/2016] [Accepted: 07/14/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Talal Mahdi
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Amr Rajab
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Ruth Padmore
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
| | - Anna Porwit
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
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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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Johansson P, Bergmann A, Rahmann S, Wohlers I, Scholtysik R, Przekopowitz M, Seifert M, Tschurtschenthaler G, Webersinke G, Jäger U, Siebert R, Klein-Hitpass L, Dührsen U, Dürig J, Küppers R. Recurrent alterations of TNFAIP3 (A20) in T-cell large granular lymphocytic leukemia. Int J Cancer 2015. [PMID: 26199174 DOI: 10.1002/ijc.29697] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The pathogenesis of T-cell large granular lymphocytic leukemia (T-LGL) is poorly understood, as STAT3 mutations are the only known frequent genetic lesions. Here, we identified non-synonymous alterations in the TNFAIP3 tumor suppressor gene in 3 of 39 T-LGL. In two cases these were somatic mutations, in one case the somatic origin was likely. A further case harbored a SNP that is a known risk allele for autoimmune diseases and B cell lymphomas. Thus, TNFAIP3 mutations represent recurrent genetic lesions in T-LGL that affect about 8% of cases, likely contributing to deregulated NF-κB activity in this leukemia.
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Affiliation(s)
- Patricia Johansson
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Anke Bergmann
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sven Rahmann
- Genome Informatics, Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Inken Wohlers
- Genome Informatics, Institute of Human Genetics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - René Scholtysik
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Martina Przekopowitz
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Marc Seifert
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Gertraud Tschurtschenthaler
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Haematology and Oncology, Linz, Austria
| | - Gerald Webersinke
- Laboratory for Molecular Biology and Tumor Cytogenetics, Department of Haematology and Oncology, Linz, Austria
| | - Ulrich Jäger
- Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Reiner Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ludger Klein-Hitpass
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Dührsen
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jan Dürig
- Department of Haematology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ralf Küppers
- Institute of Cell Biology (Cancer Research), Medical Faculty, University of Duisburg-Essen, Essen, Germany
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Wahbi A, Neel A, Perrin F, Graveleau J, Mahe B, Dejoie T, Hamidou M. Gamma heavy chain disease associated with large granular lymphocytic leukemia: A report of two cases and review of the literature. Hematology 2015. [PMID: 26222587 DOI: 10.1179/1607845415y.0000000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Gamma heavy chain diseases (γHCD) and large granular lymphocyte (LGL) leukemia are two rare lymphoproliferative diseases, respectively with B and T phenotype. Both γHCD and LGL leukemia share some similar clinical features, such as cytopenias, splenomegaly, and recurrent infections. Association of these two diseases is exceptional and suggest pathogenic link. We report two cases of γHCD associated with T-LGL leukemia. CLINICAL PRESENTATION Patient 1 was a 70-year-old woman, with lymphoplasmacytic lymphoma, refractory to chlorambucil-rituximab treatment. She developed during the follow up a γHCD with T-LGL leukemia, unresponsive to melphalan, thalidomide, and steroids, requiring supportive care. Patient 2 was a 40-year-old man with chronic severe asymptomatic neutropenia, revealing both γHCD and T-LGL leukemia. He is still well without any treatment nor complications, with 7 years follow up. CONCLUSION Several types of B lymphoproliferative disease are associated with LGL leukemia. Although exceptional, this association of two rare lymphoproliferative disorders, with a different phenotype, does not seem fortuitous.
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Affiliation(s)
- Anais Wahbi
- a Service de Médecine Interne, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
| | - Antoine Neel
- a Service de Médecine Interne, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
| | - Francois Perrin
- a Service de Médecine Interne, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
| | - Julie Graveleau
- a Service de Médecine Interne, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
| | - Beatrice Mahe
- b Service d'Hématologie, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
| | - Thomas Dejoie
- c Service de Biochimie, CHU Hôtel Dieu , 1 Place Alexis-Ricordeau, 44093 Nantes Cedex 1 , France
| | - Mohamed Hamidou
- a Service de Médecine Interne, CHU Hôtel Dieu, 1 Place Alexis-Ricordeau , 44093 Nantes Cedex 1 , France
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Okada K, Kunitomi A, Sakai K, Muranushi H, Okamoto Y, Tsukamoto T, Sugiura H, Matsui H, Jo T, Ueda T, Onishi T, Ide M, Kimura S, Notohara K, Ueda Y. Hairy Cell Leukemia with Systemic Lymphadenopathy: Detection of BRAF Mutations in Both Lymph Node and Peripheral Blood Specimens. Intern Med 2015; 54:1397-402. [PMID: 26027995 DOI: 10.2169/internalmedicine.54.2944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 47-year-old woman with pancytopenia, excessive systemic lymphadenopathy and splenomegaly was referred to our hospital. The peripheral blood (PB) smear findings indicated neutropenia with lymphoid cells exhibiting hairy projections, while the histological findings of the cervical lymph node (LN) suggested hairy cell leukemia (HCL). In addition, the BRAF V600E mutation was detected, and the immunoglobulin gene rearrangement patterns were identical in both the cervical LN and PB specimens. Based on these findings, we diagnosed the patient with systemic lymphadenopathy due to HCL. This is the first report of a BRAF mutation detected in both the PB and LN at the onset of HCL.
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Affiliation(s)
- Kazuya Okada
- Department of Hematology and Oncology, Kurashiki Central Hospital, Japan
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Abstract
PURPOSE OF REVIEW Large granular lymphocyte (LGL) syndrome comprises a clonal spectrum of T-cell and natural killer (NK)-cell LGL lymphoproliferative disorders associated with neutropenia. This review presents advances in diagnosis and therapy of LGL syndrome. RECENT FINDINGS Due to the lack of a single unique genetic or phenotypic feature and clinicopathological overlap between reactive and neoplastic entities, accurate LGL syndrome diagnosis should be based on the combination of morphologic, immunophenotypic, and molecular studies as well as clinical features. For diagnosis and monitoring of LGL proliferations, it is essential to perform flow cytometric blood and/or bone marrow analysis using a panel of monoclonal antibodies to conventional and novel T-cell and NK-cell antigens such as NK-cell receptors and T-cell receptor β-chain variable region families together with TCR gene rearrangement studies. Treatment of symptomatic cytopenias in patients with indolent LGL leukemia is still based on immunosuppressive therapy. Treatment with purine analogs and alemtuzumab may be considered as an alternative option. SUMMARY Progress in understanding the pathogenetic mechanisms of these entities, especially resistance of clonal LGLs to apoptosis, due to constitutive activation of survival signaling pathways, has its impact on identification of potential molecular therapeutic targets.
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Visco C, Barcellini W, Maura F, Neri A, Cortelezzi A, Rodeghiero F. Autoimmune cytopenias in chronic lymphocytic leukemia. Am J Hematol 2014; 89:1055-62. [PMID: 24912821 DOI: 10.1002/ajh.23785] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/28/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is frequently complicated by secondary autoimmune cytopenias (AIC) represented by autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red cell aplasia, and autoimmune granulocytopenia. The distinction of immune cytopenias from cytopenias due to bone marrow infiltration, usually associated with a worse outcome and often requiring a different treatment, is mandatory. AIHA and ITP are more frequently found in patients with unfavorable biological risk factors for CLL. AIC secondary to CLL respond less favorably to standard treatments than their primary forms, and treating the underlying CLL with chemotherapy or monoclonal antibodies may ultimately be necessary.
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Affiliation(s)
- Carlo Visco
- Department of Cell Therapy and Hematology; Ospedale San Bortolo Vicenza
| | - Wilma Barcellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
| | - Francesco Maura
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
- Department of Clinical Sciences and Community Health; University of Milan; Milan
| | - Antonino Neri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
- Department of Clinical Sciences and Community Health; University of Milan; Milan
| | - Agostino Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
- Department of Clinical Sciences and Community Health; University of Milan; Milan
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Ruchlemer R, Maayan H, Elstein D, Broide E, Reinus C, Zimran A. Hypothesis: Concordance of Gaucher disease and large granular lymphocytic leukemia has biological plausibility. Blood Cells Mol Dis 2014; 53:219-20. [PMID: 25053276 DOI: 10.1016/j.bcmd.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Rosa Ruchlemer
- Hematology Department, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Hannah Maayan
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eti Broide
- Flow Cytometry Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
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Viny AD, Maciejewski JP. High rate of both hematopoietic and solid tumors associated with large granular lymphocyte leukemia. Leuk Lymphoma 2014; 56:503-4. [DOI: 10.3109/10428194.2014.927459] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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42
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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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Tandra P, Krishnamurthy J, Bhatt VR, Newman K, Armitage JO, Akhtari M. Autoimmune cytopenias in chronic lymphocytic leukemia, facts and myths. Mediterr J Hematol Infect Dis 2013; 5:e2013068. [PMID: 24363883 PMCID: PMC3867225 DOI: 10.4084/mjhid.2013.068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/31/2013] [Indexed: 12/21/2022] Open
Abstract
CLL has been defined as presence of more than 5000 small mature appearing monoclonal B lymphocytes with a specific immunophenotype in peripheral blood. It is a well-known fact that CLL is associated with autoimmune cytopenias. CLL cells are CD5(+) B lymphocytes, and usually are not the "guilty" cells which produce autoantibodies. T cell defect is another characteristic of CLL and the total number of T cells is increased, and there is inversion of the CD4/CD8 ratio. Autoimmune hemolytic anemia (AIHA) is the most common autoimmune complication of CLL and has been reported in 10-25% of CLL patients. However, the stage-adjusted estimated rate of AIHA in CLL is about 5%. Conversely, CLL is three times more common in patients who present with AIHA. Direct agglutinin test (DAT) is positive in 7-14% of CLL patients but AIHA may also occur in DAT negative patients. Autoimmune thrombocytopenia (AIT) is the second most common complication of CLL and has been reported in 2-3% of patients. DAT is positive in AIT but presence of antiplatelet antibodies is neither diagnostic nor reliable. Autoimmune neutropenia (AIN) and pure red cell aplasia (PRCA) are very rare complications of CLL and like other autoimmune complications of CLL may occur at any clinical stage. It is believed that most case reports of AIN and PRCA in CLL actually belong to large granular lymphocytic leukemia (LGL). Non-hematologic autoimmune complications of CLL including cold agglutinin disease (CAD), paraneoplastic pemphigus (PNP), acquired angioedema, and anti-myelin associated globulin are rare. Before starting any treatment, clinicians should distinguish between autoimmune cytopenias and massive bone marrow infiltration since autoimmune complications of CLL are not necessarily equal to advanced disease with poor prognosis. According to IWCLL guideline, steroids are the mainstay of treatment of simple autoimmunity. Intravenous immunoglobulin (IVIg), cyclosporine, and rituximab are used in complex, steroid refractory cases. Monotherapy with purine analogues and alkylating agents should be avoided as they may increase CLL associated autoimmune complications.
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Affiliation(s)
- Pavankumar Tandra
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jairam Krishnamurthy
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Vijaya Raj Bhatt
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kam Newman
- Dr. Kam Newman, Section of Transfusion Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue 6-1, Cleveland, OH 44195, USA
| | - James O Armitage
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mojtaba Akhtari
- Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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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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Long-term remission of T-cell large granular lymphocyte leukemia associated with rheumatoid arthritis after rituximab therapy. Blood 2013; 122:1583-6. [DOI: 10.1182/blood-2013-03-491464] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Key Points
Rituximab may be a safe and effective therapy in patients with both large granular lymphocyte leukemia and rheumatoid arthritis. LGLL in some patients with rheumatoid arthritis may be a reactive manifestation of chronic autoantigen stimulation rather than a true concomitant malignancy.
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Pelliccia S, Di Napoli A, Naso V, Alma E, Rebecchini C, Cox MC. Very long-lasting remission of refractory T-large granular lymphocytes leukemia and myeloma by lenalidomide treatment. Eur J Haematol 2013; 91:183-6. [PMID: 23692265 DOI: 10.1111/ejh.12141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Large granular lymphocyte leukemias (LGLLs) represent a spectrum of biologically distinct lymphoproliferative diseases originating from either mature T cells (CD3+) or natural killer (NK) cells (CD3-). Both T-cell and NK-cell LGL leukemia can manifest as indolent or aggressive neoplasia. These rare lymphoproliferative disorders are often associated with autoimmune diseases and impaired hematopoiesis. Symptomatic patients are treated with immunosuppressive drugs. The co-association of T-LGLL with clonal B-cell disorders is reported in more than 10% of patients. CASE PRESENTATION We describe the case of a 57-yr-old white male patient with no history of autoimmune disorders, with refractory T-LGLL and myeloma who was treated with bortezomib and subsequently with lenalidomide. After 30 months of on-going lenalidomide therapy, the patient is in partial remission from myeloma and in continuous complete hematological remission from T-LGLL. CONCLUSIONS As far as we know, this is the first report of a patient with refractory T-LGLL treated with bortezomib and lenalidomide. As refractory T-LGLL is a challenging condition, we think that lenalidomide and bortezomib deserve further investigation.
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Affiliation(s)
- Sabrina Pelliccia
- Department of Hematology, AO Sant'Andrea, La Sapienza University, Rome, Italy.
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Dy JAL, Chen SW, Chang CH, Chang ST, Kuo SY, Ye H, Khanom F, Bandoh BN, Liu H, Chuang SS. Composite lymphoma after chemotherapy with regressed diffuse large B-cell lymphoma and transformed cytotoxic T-cell lymphoma. Leuk Lymphoma 2013; 54:1101-4. [DOI: 10.3109/10428194.2012.733876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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48
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Zhang L, Sotomayor EM, Papenhausen PR, Shao H, Moscinski LC, Sandin RL, Caceres G, Valenica H, Malafa M, List AF, Sokol L. Unusual concurrence of T-cell large granular lymphocytic leukemia with Franklin disease (gamma heavy chain disease) manifested with massive splenomegaly. Leuk Lymphoma 2012; 54:205-8. [PMID: 22694793 DOI: 10.3109/10428194.2012.697561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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49
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Monoclonal B-cell lymphocytosis (MBL, CD4+/CD8 weak T-cell large granular lymphocytic leukemia (T-LGL leukemia) and monoclonal gammopathy of unknown significance (MGUS): molecular and flow cytometry characterization of three concomitant hematological disorders. Med Oncol 2012; 29:3557-60. [PMID: 22688448 DOI: 10.1007/s12032-012-0271-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/26/2012] [Indexed: 02/03/2023]
Abstract
The diagnosis of T-cell large granular lymphocytic leukemia in association with other B-cell disorders is uncommon but not unknown. However, the concomitant presence of three hematological diseases is extraordinarily rare. We report an 88-year-old male patient with three simultaneous clonal disorders, that is, CD4+/CD8(weak) T-cell large granular lymphocytic leukemia, monoclonal gammopathy of unknown significance and monoclonal B-cell lymphocytosis. The patient has only minimal complaints and has no anemia, neutropenia or thrombocytopenia. Lymphadenopathy and hepatosplenomegaly were not present. The three disorders were characterized by flow cytometry analysis, and the clonality of the T-cell large granular lymphocytic leukemia was confirmed by polymerase chain reaction. Interestingly, the patient has different B-cell clones, given that plasma cells of monoclonal gammopathy of unknown significance exhibited a kappa light-chain restriction population and, on the other hand, B-lymphocytes of monoclonal B-cell lymphocytosis exhibited a lambda light-chain restriction population. This finding does not support the antigen-driven hypothesis for the development of multi-compartment diseases, but suggests that T-cell large granular lymphocytic expansion might represent a direct antitumor immunological response to both B-cell and plasma-cell aberrant populations, as part of the immune surveillance against malignant neoplasms.
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Clonal drift demonstrates unexpected dynamics of the T-cell repertoire in T-large granular lymphocyte leukemia. Blood 2011; 118:4384-93. [PMID: 21865345 DOI: 10.1182/blood-2011-02-338517] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
T-cell large granular lymphocyte leukemia (T-LGLL) is characterized by chronic lymphoproliferation of cytotoxic T lymphocytes (CTLs) and is associated with lineage-restricted cytopenias. Introduction of T-cell receptor (TCR) variable β-chain (Vβ) monoclonal antibodies has facilitated identification and enumeration of clonal CTLs by flow cytometry. A highly skewed TCR Vβ repertoire identified by flow cytometry is strongly associated with monoclonal CDR3 regions by quantitative sequencing and positive TCRγ rearrangement assays. Therefore, Vβ expansions can serve as surrogate markers of CTL clonality to assess clonal kinetics in T-LGLL. We analyzed the TCR repertoire in 143 patients, 71 of which were available for serial measurements over 6 to 96 months. Although the majority (38/71, 54%) maintained a consistent monoclonal expansion, many (26/71, 37%) unexpectedly displayed a change in the dominant clone, whereby the original CTL clone contracted and another emerged as demonstrated by Vβ typing. Our results demonstrate that the T-cell repertoire is more dynamic in T-LGLL than recognized previously, illustrating the heterogeneity of disorders under this categorization.
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