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Marchand T, Lamy T. The complex relationship between large granular lymphocyte leukemia and rheumatic disease. Expert Rev Clin Immunol 2024; 20:291-303. [PMID: 38105745 DOI: 10.1080/1744666x.2023.2292758] [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: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Large granular lymphocytic (LGL) leukemia is a rare lymphoproliferative disorder characterized by an expansion of clonal T or NK lymphocytes. Neutropenia-related infections represent the main clinical manifestation. Even if the disease follows an indolent course, most patients will ultimately need treatment in their lifetime. Interestingly, LGL leukemia is characterized by a high frequency of autoimmune disorders with rheumatoid arthritis being the most frequent. AREAS COVERED This review covers the pathophysiology, clinic-biological features and the advances made in the treatment of LGL leukemia. A special focus will be made on the similarities in the pathophysiology of LGL leukemia and the frequently associated rheumatic disorders. EXPERT OPINION Recent advances in the phenotypic and molecular characterization of LGL clones have uncovered the key role of JAK-STAT signaling in the pathophysiology linking leukemic cells expansion and autoimmunity. The description of the molecular landscape of T- and NK-LGL leukemia and the improved understanding of the associated rheumatic disorders open the way to the development of new targeted therapies effective on both conditions.
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Affiliation(s)
- Tony Marchand
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Université Rennes 1, Rennes, France
- UMR 1236, Université Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
| | - Thierry Lamy
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
- Université Rennes 1, Rennes, France
- UMR 1236, Université Rennes, INSERM, Etablissement Français du Sang Bretagne, Rennes, France
- CIC 1414, Rennes, France
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Rivedal M, Haaskjold YL, Berge H, Knoop T. Antiglomerular Basement Membrane Disease Possibly Triggered by Undiagnosed Renal Cell Carcinoma: A Case Report. Kidney Med 2023; 5:100709. [PMID: 37693652 PMCID: PMC10485625 DOI: 10.1016/j.xkme.2023.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Antiglomerular basement membrane (anti-GBM) disease is a rare, small-vessel vasculitis that affects the capillary beds of the kidneys and lungs. Although exceedingly rare, several case reports have described anti-GBM disease with a concurrent cancer diagnosis, suggesting a possible correlation between these 2 conditions. Herein, we describe the first known case to our knowledge of a woman in her early 60s with simultaneous anti-GBM disease and clear cell renal cell carcinoma, in which the tumor was thought to have been the substrate for anti-GBM disease. We believe that renal cell carcinoma may have contributed to the production of anti-GBM autoantibodies and, thus, anti-GBM disease. The concurrence of these 2 conditions complicated the treatment of the patient, who was hemodialysis-dependent at the time of hospital discharge. This report highlights the importance of considering anti-GBM disease as a potential diagnosis in patients with acute kidney failure, and how important it is to identify both clear cell renal cell carcinoma and anti-GBM disease at an early stage to improve outcomes.
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Affiliation(s)
- Mariell Rivedal
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yngvar Lunde Haaskjold
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hedda Berge
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Thomas Knoop
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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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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Matsui K, Kamata W, Mochida Y, Ishioka K, Moriya H, Hidaka S, Ohtake T, Tamai Y, Kobayashi S. Acquired aplastic anemia complicated with anti-glomerular basement membrane disease successfully treated with immunosuppressive therapy: a case report. BMC Nephrol 2022; 23:136. [PMID: 35392836 PMCID: PMC8991481 DOI: 10.1186/s12882-022-02772-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aplastic anemia (AA) is a rare but fatal disorder characterized by pancytopenia due to bone marrow hypoplasia. Anti-glomerular basement membrane disease (anti-GBM disease) is an immune complex small-vessel vasculitis that presents as rapidly progressive glomerulonephritis and/or pulmonary hemorrhage. Although both involve autoreactive T cells that are partially triggered by human leukocyte antigen (HLA)-DR15, there have been no reports of their co-existence and the treatment strategy is not well understood. CASE PRESENTATION A 67-year-old woman presented with fever, malaise, and acute kidney injury with proteinuria and hematuria requiring hemodialysis. She was diagnosed with anti-GBM antibody disease based on high serum anti-GBM antibody titer and crescentic glomerulonephritis on a renal biopsy. Pulse administration of methylprednisolone (MP), oral prednisolone (PSL), and plasmapheresis were performed. Only 2 weeks after the diagnosis of anti-GBM disease, the patient developed pancytopenia requiring frequent blood transfusions. The blood cell count did not recover even 1 month after discontinuing the drugs that could cause pancytopenia. Bone marrow examination showed hypocellularity without abnormal infiltrates or fibrosis, which led to the diagnosis of severe acquired AA. Further HLA phenotyping revealed that she had HLA-DR15. Increased dose of PSL with the secondary MP pulse and the addition of cyclosporine improved pancytopenia. Although she remained dialysis-dependent, anti-GBM disease and pancytopenia did not recur for more than 2 years. CONCLUSIONS We report the first case of acquired AA complicated with anti-GBM disease in an elderly woman with HLA-DR15, which was successfully treated with immunosuppressive therapy (IST). This report is valuable not only because it shows they may co-occur, but also because it provides a therapeutic option for this complex condition. It was also suggested that pancytopenia in patients with anti-GBM disease recalls serious hematologic diseases including AA that require immediate treatment based on bone marrow examination.
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Affiliation(s)
- Kenji Matsui
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan.
| | - Wataru Kamata
- Division of Hematology, Shonan Kamakura General Hospital, Kamakura, Kanawaga, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Yotaro Tamai
- Division of Hematology, Shonan Kamakura General Hospital, Kamakura, Kanawaga, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
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Zhao T, Hu N, Yu X, Su T. Case Report: Endocapillary Glomerulopathy Associated With Large Granular T Lymphocyte Leukemia. Front Immunol 2022; 12:810223. [PMID: 35145513 PMCID: PMC8821965 DOI: 10.3389/fimmu.2021.810223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022] Open
Abstract
Large granular T lymphocyte leukemia (T-LGLL) is a rare indolent lymphocyte leukemia. The clonal proliferation of T cells, which is related to STAT3 gene mutation and abnormal Fas-mediated apoptosis pathway after cell activation, plays a major role in disease progression. Some studies have found that the exogenous and continuous stimulation of endogenous antigens, such as virus infection, is related to the pathogenesis of T-LGLL. The renal pathological manifestations of T-LGLL have rarely been described. In this study, we report a case of T-LGLL with kidney involvement as proteinuria, acute kidney injury, with the appearance of circulating T-LGL infiltrating intra-glomerular capillaries, and endocapillary glomerulopathy. We also summarize reported cases of renal injury associated with LGLL.
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Piedrafita A, Vergez F, Belliere J, Prades N, Colombat M, Huart A, Rieu JB, Lagarde S, Del Bello A, Kamar N, Chauveau D, Laurent C, Oberic L, Ysebaert L, Ribes D, Faguer S. Spectrum of Kidney Disorders Associated with T-Cell Immunoclones. J Clin Med 2022; 11:jcm11030604. [PMID: 35160055 PMCID: PMC8836922 DOI: 10.3390/jcm11030604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Large granular T-cell leukemia is a clonal hematological condition often associated with autoimmune disorders. Whether small-sized T-cell clones that are otherwise asymptomatic can promote immune kidney disorders remains elusive. In this monocentric retrospective cohort in a tertiary referral center in France, we reviewed characteristics of 29 patients with T-cell clone proliferation and autoimmune kidney disorders. Next-generation sequencing of the T-cell receptor of circulating T-cells was performed in a subset of patients. The T-cell clones were detected owing to systematic screening (mean count 0.32 × 109/L, range 0.13–3.7). Strikingly, a common phenotype of acute interstitial nephropathy was observed in 22 patients (median estimated glomerular filtration rate at presentation of 22 mL/min/1.73 m2 (range 0–56)). Kidney biopsies showed polymorphic inflammatory cell infiltration (predominantly CD3+ T-cells, most of them demonstrating positive phospho-STAT3 staining) and non-necrotic granuloma in six cases. Immune-mediated glomerulopathy only or in combination with acute interstitial nephropathy was identified in eight patients. Next-generation sequencing (n = 13) identified a major T-cell clone representing more than 1% of the T-cell population in all but two patients. None had a mutation of STAT3. Twenty patients (69%) had two or more extra-kidney autoimmune diseases. Acute interstitial nephropathies were controlled with corticosteroids, cyclosporin A, or tofacitinib. Thus, we showed that small-sized T-cell clones (i.e., without lymphocytosis) undetectable without specific screening are associated with various immune kidney disorders, including a previously unrecognized phenotype characterized by severe inflammatory kidney fibrosis and lymphocytic JAK/STAT activation.
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Affiliation(s)
- Alexis Piedrafita
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
| | - François Vergez
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Julie Belliere
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Nais Prades
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Magali Colombat
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Antoine Huart
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
| | - Jean-Baptiste Rieu
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Stéphanie Lagarde
- Laboratoire d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (F.V.); (N.P.); (J.-B.R.); (S.L.)
| | - Arnaud Del Bello
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Nassim Kamar
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Dominique Chauveau
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
| | - Camille Laurent
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Lucie Oberic
- Département d’Anatomopathologie, Institut Universitaire du Cancer de Toulouse, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Loïc Ysebaert
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse-Oncopôle, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France
| | - David Ribes
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
| | - Stanislas Faguer
- Centre de Référence des Maladies Rénales Rares, Département de Néphrologie et Transplantation d’Organes, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France; (A.P.); (J.B.); (A.H.); (A.D.B.); (N.K.); (D.C.); (D.R.)
- UMR 1297 (Institut des Maladies Métaboliques et Cardiovasculaires-Team 12), Institut National de la Santé et de la Recherche Médicale, F-31000 Toulouse, France
- Faculté de Médecine Rangueil, Université Paul Sabatier-Toulouse III, F-31000 Toulouse, France; (M.C.); (C.L.); (L.Y.)
- Correspondence: ; Tel.: +33-561-323-288; Fax: +33-561-322-351
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