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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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2
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Fend F, Quintanilla-Martinez L, Klapper W. [Classification of peripheral T-cell lymphomas : News and open questions]. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:173-183. [PMID: 37115288 DOI: 10.1007/s00292-023-01192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
Recently, two new classifications were released: the International Consensus Classification (ICC) drafted by the Clinical Advisory Committee and the short version of the 5th Edition of the WHO classification of hematolymphoid tumors. In light of new clinical, morphological, and molecular data, both classifications also revised the classification of peripheral T‑cell lymphomas. In addition to relatively minor changes in terminology and disease definitions, both new classifications mirror the considerable gain of knowledge on the genetic alterations of different T‑cell lymphoma entities. The present review summarizes the most important changes for T‑cell lymphomas in both classifications, the differences between the classifications, and diagnostically relevant issues.
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Affiliation(s)
- Falko Fend
- Institut für Pathologie und Neuropathologie, Eberhard Karls Universität Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland.
| | - Leticia Quintanilla-Martinez
- Institut für Pathologie und Neuropathologie, Eberhard Karls Universität Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Deutschland
| | - Wolfram Klapper
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, Haus U33, 24105, Kiel, Deutschland.
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Gorodetskiy V, Sidorova Y, Biderman B, Kupryshina N, Ryzhikova N, Sudarikov A. STAT3 mutations in “gray-zone” cases of T-cell large granular lymphocytic leukemia associated with autoimmune rheumatic diseases. Front Med (Lausanne) 2022; 9:1000265. [PMID: 36117975 PMCID: PMC9471006 DOI: 10.3389/fmed.2022.1000265] [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: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
A persistently increased T-cell large granular lymphocyte (T-LGL) count in the blood of more than 2 × 109/L for at least 6 months is necessary for a reliable diagnosis of T-LGL leukemia. In cases with LGL counts of approximately 0.5–2 × 109/L, a diagnosis of T-LGL leukemia can be made if clonal rearrangement of T-cell receptor (TCR) genes is present and if the patient shows typical manifestations of T-LGL leukemia, such as cytopenia, splenomegaly, or concomitant autoimmune disease. However, in cases with LGL counts of less than 0.5 × 109/L, the diagnosis of T-LGL leukemia is questionable (termed as “gray-zone” cases). Although mutations in signal transducer and activator of transcription 3 (STAT3) gene are the molecular hallmark of T-LGL leukemia, their diagnostic value in the “gray-zone” cases of T-LGL leukemia has not been evaluated – our study has been aimed to examine the prevalence of STAT3 mutations in these cases. Herein, we describe 25 patients with autoimmune rheumatic diseases, neutropenia, clonal rearrangement of TCR genes, and circulating LGL count of less than 0.5 × 109/L. Splenomegaly was observed in 19 (76%) patients. Mutations in the STAT3 were detected in 56% of patients using next-generation sequencing. Importantly, in 3 patients, no involvement of the blood and bone marrow by malignant LGLs was noted, but examination of splenic tissue revealed infiltration by clonal cytotoxic T-lymphocytes within the red pulp, with greater prominence in the cords. We suggest using the term “splenic variant of T-LGL leukemia” for such cases.
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Affiliation(s)
- Vadim Gorodetskiy
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
- *Correspondence: Vadim Gorodetskiy,
| | - Yulia Sidorova
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Bella Biderman
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Natalia Kupryshina
- Hematopoiesis Immunology Laboratory, Russian Cancer Research Center N.N. Blokhin, Moscow, Russia
| | - Natalya Ryzhikova
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
| | - Andrey Sudarikov
- Laboratory of Molecular Hematology, National Medical Research Center for Hematology, Moscow, Russia
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Gamma/Delta (γδ) T Cells: The Role of the T-Cell Receptor in Diagnosis and Prognosis of Hematologic Malignancies. Am J Dermatopathol 2022; 44:237-248. [PMID: 35287137 DOI: 10.1097/dad.0000000000002041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT There are 2 types of T cells: αβ and γδ T cells, named based on the composition of the T-cell receptor. γδ T cells are rare, making up 0.5%-10% of T cells. Although most leukemias, lymphomas, and immune-mediated conditions derive from αβ T cells, a handful of rare but important diseases are generally derived from γδ T cells, particularly primary cutaneous γδ T-cell lymphoma, hepatosplenic T-cell lymphoma, and monomorphic epitheliotropic intestinal T-cell lymphoma. There are also malignancies that may evince a γδ TCR phenotype, including large granulocytic lymphocyte leukemia, T-cell acute lymphobplastic leukemia (T-ALL), and mycosis fungoides, although such cases are rare. In this article, we will review the genesis of the T-cell receptor, the role of γδ T cells, and the importance of TCR type and methods of detection and outline the evidence for prognostic significance (or lack thereof) in lymphomas of γδ T cells. We will also highlight conditions that rarely may present with a γδ TCR phenotype and assess the utility of testing for TCR type in these diseases.
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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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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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Abstract
T-cell lymphoproliferative processes in the spleen are rare and it is important to study normal T cell subsets in the spleen to understand the splenic milieu in which they arise. True malignant T-cell processes including hepatosplenic T-cell lymphoma and T-cell large granular lymphocytic leukemia occur in the spleen, but other atypical reactive T-cell proliferations and those of uncertain significance also have been described. Proper distinction of florid T cell responses from malignant T-cell neoplasms has important therapeutic implications for the patient.
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Affiliation(s)
- Nadine S Aguilera
- Department of Pathology, University of Virginia Health System, Charlottesville VA 22908-0214, United States.
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Barilà G, Calabretto G, Teramo A, Vicenzetto C, Gasparini VR, Semenzato G, Zambello R. T cell large granular lymphocyte leukemia and chronic NK lymphocytosis. Best Pract Res Clin Haematol 2019; 32:207-216. [DOI: 10.1016/j.beha.2019.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/26/2023]
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Wang L, Zhou Y, Tang J, Zhan Q, Liao Y. [CD4(-)/CD8(-)/CD56(+)/TCRγδ(+) T-cell large granular lymphocyte leukemia presenting as aplastic anemia: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:525-527. [PMID: 31340629 PMCID: PMC7342393 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L Wang
- Department of Hematology, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - Y Zhou
- Department of Clinical Laboratory, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - J Tang
- Department of Clinical Laboratory, Chongqing the Fourth Hospital, Chongqing 400014, China
| | - Q Zhan
- Clinical Molecular Medicine Testing Center, First Affiliated Hospital of Chongqing Medicial University, Chongqing 400016, China
| | - Y Liao
- Department of Hematology, Chongqing the Fourth Hospital, Chongqing 400014, China
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Myasthenia gravis and large granular lymphocytic leukemia. Med Clin (Barc) 2019; 152:163-164. [PMID: 30001897 DOI: 10.1016/j.medcli.2018.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 01/06/2023]
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Vakrakou AG, Tzanetakos D, Valsami S, Grigoriou E, Psarra K, Tzartos J, Anagnostouli M, Andreadou E, Evangelopoulos ME, Koutsis G, Chrysovitsanou C, Gialafos E, Dimitrakopoulos A, Stefanis L, Kilidireas C. A case of Alemtuzumab-induced neutropenia in multiple sclerosis in association with the expansion of large granular lymphocytes. BMC Neurol 2018; 18:178. [PMID: 30373566 PMCID: PMC6206708 DOI: 10.1186/s12883-018-1183-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in Multiple Sclerosis (MS) patients compared to β-interferon. It acts against CD52, leading primarily to lymphopenia. Recent data have shown that mild neutropenia is observed in 16% of treated MS-patients whereas severe neutropenia occurred in 0.6%. CASE PRESENTATION Herein, we present the case of a 34-year-old woman with relapsing-remitting MS, with a history of treatment with glatiramer acetate and natalizumab, who subsequently received Alemtuzumab (12 mg / 24 h × 5 days). 70-days after the last Alemtuzumab administration, the patient displayed neutropenia (500 neutrophils/μL) with virtual absence of B-cells (0.6% of total lymphocytes), low values of CD4-T-cells (6.6%) and predominance of CD8-T-cells (48%) and NK-cells (47%); while large granular lymphocytes (LGL) predominated in the blood-smear examination. Due to prolonged neutropenia (5-days) the patient was placed on low-dose corticosteroids leading to sustained remission. CONCLUSION This is the first case of a patient with relapsing-remitting MS with neutropenia two months post-Alemtuzumab, with simultaneous presence of LGL cells in the blood and a robust therapeutic response to prednisolone. We recommend testing with a complete blood count every 15 days in the first 3 months after the 1st Alemtuzumab administration and searching for large granular lymphocytes cell expansion on microscopic examination of the peripheral blood if neutropenia develops.
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Affiliation(s)
- A. G. Vakrakou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - D. Tzanetakos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - S. Valsami
- Department of Blood Transfusion, Medical School of Athens, National & Kapodistrian University, Aretaieion Hospital, Athens, Greece
| | - E. Grigoriou
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - K. Psarra
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - J. Tzartos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - M. Anagnostouli
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - E. Andreadou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - M. E. Evangelopoulos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - G. Koutsis
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - C. Chrysovitsanou
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - E. Gialafos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - A. Dimitrakopoulos
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - L. Stefanis
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
| | - C. Kilidireas
- 1st Department of Neurology, Medical School of Athens, National & Kapodistrian University, Aeginition Hospital, Athens, Greece
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Cazzini P, Krimer PM, Williams-Fritze MJ, Butler AM, Blas-Machado U. Spontaneous chronic T-cell leukemia in a male rhesus macaque ( Macaca mulatta). J Vet Diagn Invest 2018; 26:571-574. [PMID: 24760134 DOI: 10.1177/1040638714532339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Blood smears from a 24-year-old male rhesus macaque ( Macaca mulatta) used for cognitive function studies were evaluated. The macaque had an 8-month history of gradual weight loss and increasing lymphocytosis. Most of the lymphocytes present were small to medium and had a mature morphology. Based on the degree and duration of the lymphocytosis, and the appearance of the lymphocytes, a diagnosis of chronic lymphocytic leukemia was made. The animal tested negative for 4 viral diseases that are commonly associated with lymphoproliferative disorders in Old World monkeys. Over the course of 12 months, the lymphocytosis progressed from 18.4 to 384 × 103 lymphocytes/µl (reference range: 0.8-17 × 103 cells/µl), and euthanasia was elected. On histologic examination, cluster of differentiation (CD)3- and CD8-positive, CD79-negative neoplastic cells comprised 40-60% of the bone marrow, diffusely obscured the normal splenic architecture, and were present in the vascular channels in other organs. Findings were characteristic of T-cell lymphocytic leukemia. Naturally occurring T-cell lymphocytic leukemia has been rarely reported in rhesus macaques and, to the authors' knowledge, never in males. A persistent lymphocytosis characterized by a monomorphic population of CD3- and CD8-positive cytotoxic T-lymphocytes and the presence of neoplastic cells in the bone marrow led to a diagnosis in the current case.
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Affiliation(s)
- Paola Cazzini
- Department of Pathology (Cazzini, Krimer, Butler, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Athens Veterinary Diagnostic Laboratory (Krimer, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Laboratory Animal Services, Georgia Regents University, Augusta, GA (Williams-Fritze)
| | - Paula M Krimer
- Department of Pathology (Cazzini, Krimer, Butler, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Athens Veterinary Diagnostic Laboratory (Krimer, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Laboratory Animal Services, Georgia Regents University, Augusta, GA (Williams-Fritze)
| | - Misty J Williams-Fritze
- Department of Pathology (Cazzini, Krimer, Butler, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Athens Veterinary Diagnostic Laboratory (Krimer, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Laboratory Animal Services, Georgia Regents University, Augusta, GA (Williams-Fritze)
| | - Abigail M Butler
- Department of Pathology (Cazzini, Krimer, Butler, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Athens Veterinary Diagnostic Laboratory (Krimer, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Laboratory Animal Services, Georgia Regents University, Augusta, GA (Williams-Fritze)
| | - Uriel Blas-Machado
- Department of Pathology (Cazzini, Krimer, Butler, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Athens Veterinary Diagnostic Laboratory (Krimer, Blas-Machado), College of Veterinary Medicine, University of Georgia, Athens, GA.,Laboratory Animal Services, Georgia Regents University, Augusta, GA (Williams-Fritze)
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Poch Martell M, Hamad N, Shin E, Moon JH, Sohn SK, Uhm J, Michelis FV, Viswabandya A, Lipton JH, Messner HA, Kim DDH. Distinctive clinical characteristics and favorable outcomes in patients with large granular lymphocytosis after allo-HCT: 12-year follow-up data. Eur J Haematol 2017; 99:160-168. [DOI: 10.1111/ejh.12899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Marc Poch Martell
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Nada Hamad
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Elizabeth Shin
- Faculty of Medicine; University of Toronto; Toronto Canada
| | - Joon Ho Moon
- Department of Hematology/Oncology; Kyungpook National University Hospital, Kyungpook National University; Daegu Korea
| | - Sang Kyun Sohn
- Department of Hematology/Oncology; Kyungpook National University Hospital, Kyungpook National University; Daegu Korea
| | - Jieun Uhm
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Fotios V. Michelis
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Auro Viswabandya
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Jeffrey H. Lipton
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Hans A. Messner
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
| | - Dennis Dong Hwan Kim
- Department of Medical Oncology & Hematology, Princess Margaret Cancer Centre; University Health Network, University of Toronto; Toronto Canada
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Papadantonakis P, Kaparou M, Papadaki HA, Marinos L, Krasagakis K. Multiple cutaneous reticulohistiocytosis with T-cell large granular lymphocyte clonopathy. Australas J Dermatol 2017; 58:e249-e252. [DOI: 10.1111/ajd.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 11/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Pavlos Papadantonakis
- Department of Dermatology; University General Hospital of Heraklion; Heraklion Crete Greece
| | - Maria Kaparou
- Department of Haematology; University General Hospital of Heraklion; Heraklion Crete Greece
| | - Helen A Papadaki
- Department of Haematology; University General Hospital of Heraklion; Heraklion Crete Greece
| | - Leonidas Marinos
- Department of Haematopathology; Evangelismos Hospital; Athens Greece
| | - Konstantin Krasagakis
- Department of Dermatology; University General Hospital of Heraklion; Heraklion Crete Greece
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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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A screening method with lymphocyte percentage and proportion of granular lymphocytes in the peripheral blood for large granular lymphocyte (LGL) leukemia. Int J Hematol 2016; 105:87-91. [DOI: 10.1007/s12185-016-2092-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 11/27/2022]
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Faria AWC, da Silva AM, de Souza Rodrigues T, Costa MA, Braga AP. A Ranking Approach for Probe Selection and Classification of Microarray Data with Artificial Neural Networks. J Comput Biol 2016; 22:953-61. [PMID: 26418055 DOI: 10.1089/cmb.2013.0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acute leukemia classification into its myeloid and lymphoblastic subtypes is usually accomplished according to the morphology of the tumor. Nevertheless, the subtypes may have similar histopathological appearance, making screening procedures difficult. In addition, approximately one-third of acute myeloid leukemias are characterized by aberrant cytoplasmic localization of nucleophosmin (NPMc(+)), where the majority has a normal karyotype. This work is based on two DNA microarray datasets, available publicly, to differentiate leukemia subtypes. The datasets were split into training and test sets, and feature selection methods were applied. Artificial neural network classifiers were developed to compare the feature selection methods. For the first dataset, 50 genes selected using the best classifier was able to classify all patients in the test set. For the second dataset, five genes yielded 97.5% accuracy in the test set.
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Affiliation(s)
| | | | - Thiago de Souza Rodrigues
- 2 Computer Department, Federal Center of Technological Education of Minas Gerais , Belo Horizonte, MG, Brazil
| | - Marcelo Azevedo Costa
- 1 Graduate Program in Electrical Engineering, Federal University of Minas Gerais , Belo Horizonte, MG, Brazil
| | - Antonio Padua Braga
- 1 Graduate Program in Electrical Engineering, Federal University of Minas Gerais , Belo Horizonte, MG, Brazil
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Sreedharanunni S, Sachdeva M, Prakash G, Das R. Persistent γδ T large granular lymphocytosis in a patient with refractory pure red cell aplasia, celiac disease, and chronic hepatitis B infection. J Postgrad Med 2016; 62:40-3. [PMID: 26515990 PMCID: PMC4944328 DOI: 10.4103/0022-3859.168739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The disorders of large granular lymphocytes include reactive proliferation as well as indolent or aggressive neoplasms of cytotoxic T cells, γδ T cells, and natural killer (NK) cells. They are associated with autoimmune and infectious disorders and have varied immunophenotypic features. We report a case, which highlights this complex association of autoimmune and infectious diseases with large granular lymphocytosis, the overlapping spectrum of large granular lymphocyte leukemias, and γδ T cell lymphomas as well as the difficulties in the diagnosis and management of these indolent T cell lymphomas in the usual clinical settings.
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Affiliation(s)
| | | | | | - R Das
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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[CD4⁺/CD8⁻ T- cell large granular lymphocytic leukemia: one case report and literatures reviews]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:739-42. [PMID: 26462772 PMCID: PMC7342710 DOI: 10.3760/cma.j.issn.0253-2727.2015.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
目的 提高对CD4+/CD8−T-大颗粒淋巴细胞白血病的认识。 方法 分析1例因皮疹、白细胞增多就诊的CD4+/CD8−T-大颗粒淋巴细胞白血病患者的临床资料,并复习相关文献。 结果 患者为老年女性,周身散在片状紫红色斑疹,外周血大颗粒淋巴细胞增多,呈CD3+/CD4+/CD8−免疫表型,PCR检测TCRγ、β基因重排阳性,流式细胞术检测TCRVβ2亚家族98%。 结论 CD3+/CD4+/CD8−变异型T-大颗粒淋巴细胞白血病少见,临床表现与经典T-大颗粒淋巴细胞白血病有所不同,应谨慎鉴别。
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Wang W, Gao L, Gong M, Tang Y, Li Y, Zhang WT, Huang FZ, Zhang CX, Chen YR, Gao YY, Li ZL, Ma YG. Non-malignant T-cells lacking multiple pan-T markers can be found in lymph nodes. Leuk Lymphoma 2015; 59:155-161. [PMID: 26293843 DOI: 10.3109/10428194.2015.1055482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wei Wang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Li Gao
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Ming Gong
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yin Tang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yan Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Wen-Tao Zhang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Fan-Zhou Huang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Chun-Xia Zhang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yan-Rong Chen
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Ya-Yue Gao
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Zhen-Ling Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yi-Gai Ma
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
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Covach A, Leith CP, Rajguru SA, Yang DT. A unique CD4+ large granular lymphocytosis occurring in patients treated with tumor necrosis factor α inhibitors: report of 2 cases. Hum Pathol 2015; 46:1237-41. [DOI: 10.1016/j.humpath.2015.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/04/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Bektas O, Uner A, Aydin SM, Eliacik E, Uz B, Işık A, Haznedaroğlu IC, Goker H, Sayinalp N, Aksu S, Demiroglu H, Ozcebe OI, Buyukasik Y. High frequency of autonomous T-cell proliferation compatible with T-cell large granular lymphocytic leukemia in patients with cytopenia of unknown etiology. Int J Hematol 2015; 102:211-7. [PMID: 26009282 DOI: 10.1007/s12185-015-1816-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023]
Abstract
Large granular lymphocytic leukemia/lymphoproliferative disorder (LGL-L/LPD) is a heterogeneous neoplastic disease of large granular lymphocytes and is a well-known cause of cytopenias. We aimed to reveal the incidence of LGL-L/LPD in patients with cytopenia(s) of unknown etiology (CUE). Twenty-eight patients with CUE were investigated for LGL-L/LPD. T-cell LGL leukemia (LGL-L) was diagnosed in 12 (42.9 %) patients. The frequencies of LGL-L in patients who had anemia, neutropenia, and thrombocytopenia were 9/14 (64.2 %), 11/23 (47.8 %), and 3/10 (30 %), respectively. Seventeen of the 28 patients met the criteria of idiopathic cytopenia of undetermined significance (ICUS), and LGL-L was found in six (35.3 %) of them. We conclude that LGL-L is a rather common disease in patients with CUE and ICUS. It should be considered in this patient group and investigated thoroughly.
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Affiliation(s)
- Ozlen Bektas
- Department of Hematology, Faculty of Medicine, Hacettepe University, 06100, Sihhiye, Ankara, Turkey
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Sylvia MT, Jacob SE, Basu D, Amalnath D, Dutta TK. CD56 Negative Aggressive T Cell Large Granular Lymphocytic Leukemia. Indian J Hematol Blood Transfus 2015; 32:121-4. [PMID: 27408372 DOI: 10.1007/s12288-015-0502-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/07/2015] [Indexed: 01/23/2023] Open
Abstract
T cell large granular lymphocytic leukemia is a clonal proliferation of cytotoxic large granular T cells positive for CD3 and CD8. It is a chronic lymphoproliferative disorder with an indolent course. Therapeutic options include observation and low dose chemotherapy. Rarely, they have an aggressive course. Such cases have expression of NK cell associated antigens like CD56 in the T cells. These cases require more aggressive therapy with acute lymphoblastic leukemia regimens. We report a case of fatal CD56 negative T cell large granular lymphocytic leukemia in a 38 year old lady.
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Affiliation(s)
- Mary Theresa Sylvia
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Gorimedu, Puducherry, 605011 Puducherry India
| | - Sajini Elizabeth Jacob
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Gorimedu, Puducherry, 605011 Puducherry India
| | - Debdatta Basu
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Gorimedu, Puducherry, 605011 Puducherry India
| | - Deepak Amalnath
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Gorimedu, Puducherry, 605011 Puducherry India
| | - Tarun Kumar Dutta
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Gorimedu, Puducherry, 605011 Puducherry India
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Owlia MB, Newman K, Akhtari M. Felty's Syndrome, Insights and Updates. Open Rheumatol J 2014; 8:129-36. [PMID: 25614773 PMCID: PMC4296472 DOI: 10.2174/1874312901408010129] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022] Open
Abstract
Felty’s syndrome (FS) is characterized by the triad of seropositive rheumatoid arthritis (RA) with destructive joint involvement, splenomegaly and neutropenia. Current data shows that 1-3 % of RA patients are complicated with FS with an estimated prevalence of 10 per 100,000 populations. The complete triad is not an absolute requirement, but persistent neutropenia with an absolute neutrophil count (ANC) generally less than 1500/mm3 is necessary for establishing the diagnosis. Felty’s syndrome may be asymptomatic but serious local or systemic infections may be the first clue to the diagnosis. FS is easily overlooked by parallel diagnoses of Sjӧgren syndrome or systemic lupus erythematosus or lymphohematopoietic malignancies. The role of genetic (HLA DR4) is more prominent in FS in comparison to classic rheumatoid arthritis. There is large body of evidence that in FS patients, both cellular and humoral immune systems participate in neutrophil activation, and apoptosis and its adherence to endothelial cells in the spleen.
It has been demonstrated that proinflammatory cytokines may have inhibitory effects on bone marrow granulopoiesis. Binding of IgGs to neutrophil extracellular chromatin traps (NET) leading to neutrophil death plays a crucial role in its pathophysiology. In turn, "Netting" neutrophils may activate auto-reactive B cells leading to further antibody and immune complex formation. In this review we discuss on basic pathophysiology, epidemiology, genetics, clinical, laboratory and treatment updates of Felty’s syndrome.
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Affiliation(s)
- Mohammad Bagher Owlia
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Kam Newman
- Rheumatology Program, National Institute of Arthritis, Musculoskeletal, and Skin Disease (NIAMS), National Institutes of Health, 10 Center Drive, Room 6N216, Bethesda, MD 20892-1616, USA
| | - Mojtaba Akhtari
- Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, University of Southern California (USC)/Norris Cancer Center, USC University Hospital, 1441 Eastlake Avenue, Norris Topping Tower 3463, MC 9172, Los Angeles, CA 90033-9172, USA
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Kataria A, Cohen E, Saad E, Atallah E, Bresnahan B. Large granular lymphocytic leukemia presenting late after solid organ transplantation: a case series of four patients and review of the literature. Transplant Proc 2014; 46:3278-81. [PMID: 25240311 DOI: 10.1016/j.transproceed.2014.05.083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a significant complication of solid organ transplantation. Most PTLD is of the B-cell subtype, although T-cell subtype PTLD uncommonly occurs. T-cell PTLDs are usually aggressive neoplasms and shorten patient and allograft survivals significantly. We present a single-center case series of 4 patients who developed T-cell large granular lymphocytic (LGL) leukemia, a rare T-cell PTLD characterized by large granular lymphocytes that have characteristic azurophilic granules and a highly variable clinical course.
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Affiliation(s)
- A Kataria
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - E Cohen
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Medicine, Veterans Administration Zablocki Medical Center, Milwaukee, Wisconsin
| | - E Saad
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - E Atallah
- Division of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - B Bresnahan
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
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27
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Mutreja D, Sharma RK, Kotru M, Saxena R. CD4 positive/CD8 negative/CD56 positive T cell large granular lymphocyte proliferations; clonal disorders of uncertain significance. BMC HEMATOLOGY 2014. [DOI: 10.1186/2052-1839-14-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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28
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Adamkovich N, Kispál M, Krenács L, Bagdi E, Borbényi Z. [Large granular lymphocytic leukemia. A rare disease with personalized treatment options]. Orv Hetil 2014; 155:414-9. [PMID: 24613776 DOI: 10.1556/oh.2014.29830] [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: 11/19/2022]
Abstract
INTRODUCTION Large granular lymphocyte leukemia is rare, mainly chronic disease. The most common complication is neutropenia, but other immune-mediated cytopenia may also occur. There are no unified treatment recommendations and initiation of treatment mainly depends on the severity of the symptoms. AIM The aim of the authors was to analyze the main steps of the diagnosis and the necessity and outcome of treatment in their patients diagnosed with large granular lymphocyte leukaemia. METHOD The authors retrospectively analyzed the data of 17 large granular lymphocyte leukemia patients. RESULTS Of the 17 patients, 7 patients required treatment because of transfusion dependent anemia (4 patients) or neutropenia (3 patients). In 4 patients corticosteroid was given (supplemented with cyclosporine in one patients), while the other patients received anti-CD52 (one patient), low dose methotrexate (one patient) and combined chemotherapy (one patient). Five patients achieved partial response, and two patients died in sepsis. CONCLUSIONS In this cohort only a smaller proportion of patients required therapy. Immunosuppression can be successful, but the effect in most cases was temporary. The most serious complication was sepsis, which is associated with a significant risk of mortality in cases with neutropenia.
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Affiliation(s)
- Nóra Adamkovich
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Hematológiai Osztály Szeged Korányi fasor 6. 6720
| | | | - László Krenács
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Daganatpatológiai és Molekuláris Diagnosztikai Laboratórium Szeged
| | - Enikő Bagdi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Daganatpatológiai és Molekuláris Diagnosztikai Laboratórium Szeged
| | - Zita Borbényi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika és Kardiológiai Központ, Hematológiai Osztály Szeged Korányi fasor 6. 6720
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Steinway SN, LeBlanc F, Loughran TP. The pathogenesis and treatment of large granular lymphocyte leukemia. Blood Rev 2014; 28:87-94. [PMID: 24679833 DOI: 10.1016/j.blre.2014.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Abstract
Large granular lymphocyte (LGL) leukemia is a spectrum of rare lymphoproliferative diseases of T lymphocytes and natural killer cells. These diseases frequently present with splenomegaly, neutropenia, and autoimmune diseases like rheumatoid arthritis. LGL leukemia is more commonly of a chronic, indolent nature; however, rarely, they have an aggressive course. LGL leukemia is thought to arise from chronic antigen stimulation, which drives long-term cell survival through the activation of survival signaling pathways and suppression of pro-apoptotic signals. These include Jak-Stat, Mapk, Pi3k-Akt, sphingolipid, and IL-15/Pdgf signaling. Treatment traditionally includes immunosuppression with low dose methotrexate, cyclophosphamide, and other immunosuppressive agents; however, prospective and retrospective studies reveal very limited success. New studies surrounding Jak-Stat signaling suggest this may reveal new avenues for LGL leukemia therapeutics.
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Affiliation(s)
| | - Francis LeBlanc
- Penn State Hershey Cancer Institute, Penn State College of Medicine, Hershey, PA, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.
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Papadaki HA, Pontikoglou C. Pathophysiologic mechanisms, clinical features and treatment of idiopathic neutropenia. Expert Rev Hematol 2014; 1:217-29. [DOI: 10.1586/17474086.1.2.217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Ren T, Yang J, Broeg K, Liu X, Loughran TP, Cheng H. Developing an in vitro model of T cell type of large granular lymphocyte leukemia. Leuk Res 2013; 37:1737-43. [PMID: 24183305 DOI: 10.1016/j.leukres.2013.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 09/19/2013] [Accepted: 10/04/2013] [Indexed: 01/11/2023]
Abstract
We developed a strategy that can prolong in vitro growth of T cell type of large granular lymphocyte (T-LGL) leukemia cells. Primary CD8+ lymphocytes from T-LGL leukemia patients were stably transduced with the retroviral tax gene derived from human T cell leukemia virus type 2. Expression of Tax overrode replicative senescence and promoted clonal expansion of the leukemic CD8+ T cells. These cells exhibit features characteristic of leukemic LGL, including resistance to FasL-mediated apoptosis, sensitivity to the inhibitors of sphingosine-1-phosphate receptor and IκB kinases as well as expression of cytotoxic gene products such as granzyme B, perforin and IFNγ. Collectively, these results indicate that this leukemia cell model can duplicate the main phenotype and pathophysiological characteristics of the clinical isolates of T-LGL leukemia. This model should be useful for investigating molecular pathogenesis of the disease and for developing new therapeutics targeting T-LGL leukemia.
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Affiliation(s)
- Tong Ren
- Penn State Hershey Cancer Institute, Penn State University College of Medicine, Hershey, PA 17033, United States
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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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Bockorny B, Dasanu CA. Autoimmune manifestations in large granular lymphocyte leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 12:400-5. [PMID: 22999943 DOI: 10.1016/j.clml.2012.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/17/2012] [Accepted: 06/15/2012] [Indexed: 12/16/2022]
Abstract
Large granular lymphocyte (LGL) leukemia features a group of indolent lymphoproliferative diseases that display a strong association with various autoimmune conditions. Notwithstanding, these autoimmune conditions have not been comprehensively characterized or systematized to date. As a result, their clinical implications remain largely unknown. The authors offer a comprehensive review of the existing literature on various autoimmune conditions documented in the course of T-cell LGL (T-LGL) leukemia. Though some of them are thought be secondary to the LGL leukemia, others could be primary and might even play a role in its pathogenesis. A considerable clinico-laboratory overlap between T-LGL leukemia associated with rheumatoid arthritis and Felty's syndrome suggests that they are just different eponyms for the same clinical entity.
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Affiliation(s)
- Bruno Bockorny
- Department of Medicine, University of Connecticut Medical Center, Farmington, CT 06030-1235, USA.
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Costa RO, Bellesso M, Chamone DAF, Ruiz MA, Hallack Neto AE, Aldred VL, Pereira J. T-cell large granular lymphocytic leukemia: treatment experience with fludarabine. Clinics (Sao Paulo) 2012; 67:745-8. [PMID: 22892917 PMCID: PMC3400163 DOI: 10.6061/clinics/2012(07)07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 03/18/2012] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of this retrospective study was to investigate the results of T-cell large granular lymphocytic leukemia treatment with fludarabine by assessing the complete hematologic response, the complete molecular response, progression-free survival, and overall survival. METHODS We evaluated the records of six patients with T-cell large granular lymphocytic leukemia who were treated with fludarabine as a first-, second-, or third-line therapy, at a dose of 40 mg/m², for three to five days per month and 6 to 8 cycles. RESULTS Of the six patients investigated with T-cell large granular lymphocytic leukemia who were treated with fludarabine, five (83.3%) were female, and their median age was 36.5 years (range 18 to 73). The median lymphocyte level was 3.4 x 10(9)/L (0.5 to 8.9). All patients exhibited a monoclonal T-cell receptor gamma gene rearrangement at diagnosis. Two (33.3%) patients received fludarabine as first-line treatment, two (33.3%) for refractory disease, one (16.6%) for relapsed disease after the suspension of methotrexate treatment due to liver toxicity, and one (16.6%) due to dyspepsia. A complete hematologic response was achieved in all cases, and a complete molecular response was achieved in five out six cases (83.3%). During a mean follow-up period of 12 months, both the progression-free survival and overall survival rates were 100%. CONCLUSION T-cell large granular lymphocytic leukemia demonstrated a high rate of complete hematologic and molecular response to fludarabine, with excellent compliance and tolerability rates. To confirm our results in this rare disease, we believe that fludarabine should be tested in clinical trials as a first-line treatment for T-cell large granular lymphocytic leukemia.
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Affiliation(s)
- Renata Oliveira Costa
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo Hematology Department, São Paulo/SP, Brazil
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Petsa PK, Karamoutsios A, Dova L, Benetatos L, Petsiou A, Kolaitis N, Georgopoulos A, Vartholomatos G. Asymptomatic T-cell large granular lymphocyte leukemia with an unusual immunophenotype. Clin Pract 2012; 2:e68. [PMID: 24765467 PMCID: PMC3981314 DOI: 10.4081/cp.2012.e68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 11/22/2022] Open
Abstract
T-cell large granular lymphocyte (T-LGL) leukemia represents a clonal proliferation of cytotoxic T-cells which etiology has not been entirely elucidated. However, CD4+, CD4−, CD8−, CD4+, CD8+ cases have been described. The disease is usually characterized by cytopenias and a modest lymphocytosis. The majority of patients with T-LGL leukemia remains asymptomatic for a long period and will require treatment later during the course of their disease. Hereby we describe a case of T-LGL leukemia diagnosed by flow cytometry, which presented indolent course and required no treatment so far.
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Affiliation(s)
- Panagiota K Petsa
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | | | - Lefkothea Dova
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | - Leonidas Benetatos
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
| | - Asimina Petsiou
- Laboratory of Hematology, Unit of Molecular Biology, University Hospital of Ioannina
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Patkar N, Nair S, Alex AA, Parihar M, Manipadam MT, Arora N, Ahmed R, Abraham A, George B, Viswabandya A, Srivastava V, Srivastava A, Mathews V. Clinicopathological features of hepatosplenic T cell lymphoma: a single centre experience from India. Leuk Lymphoma 2012; 53:609-15. [DOI: 10.3109/10428194.2011.622421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Neutropenia is a common reason for hematology consultations in the inpatient and outpatient settings and is defined as an absolute neutrophil count less than 1500 cells/μL. Neutropenia varies in severity, with more profound neutropenia being associated with higher rates of infections and infection-related deaths. The causes for neutropenia are diverse and include congenital and acquired conditions (ie, autoimmune, drugs, infection, and malignancy). This article outlines the most common causes of neutropenia and discusses differential diagnoses, treatment modalities, and the mechanisms by which neutropenia occurs.
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Gill H, Ip AHW, Leung R, So JCC, Pang AWK, Tse E, Leung AYH, Lie AKW, Kwong YL. Indolent T-cell large granular lymphocyte leukaemia after haematopoietic SCT: a clinicopathologic and molecular analysis. Bone Marrow Transplant 2011; 47:952-6. [DOI: 10.1038/bmt.2011.212] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Large granular lymphocyte (LGL) leukemia is characterized by a clonal expansion of either CD3(+) cytotoxic T or CD3(-) NK cells. Prominent clinical features of T-LGL leukemia include neutropenia, anemia and rheumatoid arthritis (RA). The terminal effector memory phenotype (CD3(+)/CD45RA(+)/CD62L(-)CD57(+)) of T-LGL suggests a pivotal chronic antigen-driven immune response. LGL survival is then promoted by platelet-derived growth factor and interleukin-15, resulting in global dysregulation of apoptosis and resistance to normal pathways of activation-induced cell death. These pathogenic features explain why treatment of T-LGL leukemia is based on immunosuppressive therapy. The majority of these patients eventually need treatment because of severe or symptomatic neutropenia, anemia, or RA. No standard therapy has been established because of the absence of large prospective trials. The authors use low-dose methotrexate initially for T-LGL leukemia patients with neutropenia and/or RA. We recommend either methotrexate or oral cyclophosphamide as initial therapy for anemia. If treatment is not successful, patients are switched to either the other agent or cyclosporine. The majority of patients experience an indolent clinical course. Deaths infrequently occur because of infections related to severe neutropenia. As there are no curative therapeutic modalities for T-LGL leukemia, new treatment options are needed.
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Zlobec I, Karamitopoulou E, Terracciano L, Piscuoglio S, Iezzi G, Muraro MG, Spagnoli G, Baker K, Tzankov A, Lugli A. TIA-1 cytotoxic granule-associated RNA binding protein improves the prognostic performance of CD8 in mismatch repair-proficient colorectal cancer. PLoS One 2010; 5:e14282. [PMID: 21179245 PMCID: PMC3003488 DOI: 10.1371/journal.pone.0014282] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 11/16/2010] [Indexed: 12/22/2022] Open
Abstract
Background Evidence suggests a confounding effect of mismatch repair (MMR) status on immune response in colorectal cancer. The identification of innate and adaptive immune cells, that can complement the established prognostic effect of CD8 in MMR-proficient colorectal cancers patients, representing 85% of all cases, has not been performed. Methodology/Principal Findings Colorectal cancers from a test (n = 1197) and external validation (n = 209) cohort of MMR-proficient colorectal cancers were mounted onto single and multiple punch tissue microarrays. Immunohistochemical quantification (score 0-3) was performed for CD3, CD4, CD8, CD45RO, CD68, CD163, FoxP3, GranzymeB, iNOS, mast cell tryptase, MUM1, PD1 and TIA-1 tumor-infiltrating (TILs) reactive cells. Coexpression experiments on fresh colorectal cancer specimens using specific cell population markers were performed. In the test group, higher numbers of CD3+ (p<0.001), CD4+ (p = 0.029), CD8+ (p<0.001), CD45RO+ (p = 0.048), FoxP3+ (p<0.001), GranzymeB+ (p<0.001), iNOS+ (p = 0.035), MUM1+ (p = 0.014), PD1+ (p = 0.034) and TIA-1+ TILs (p<0.001) were linked to favourable outcome. Adjusting for age, gender, TNM stage and post-operative therapy, higher CD8+ (p<0.001; HR (95%CI): 0.66 (0.64-0.68)) and TIA-1+ (p<0.001; HR (95%CI): 0.56 (0.5-0.6)) were independent prognostic factors. Moreover, among patients with CD8+ infiltrates, TIA-1 further stratified 355 (35.6%) patients into prognostic subgroups (p<0.001; HR (95%CI): 0.89 (95%CI: 0.8-0.9)). Results were confirmed on the validation cohort (p = 0.006). TIA-1+ cells were mostly CD8+ (57%), but also stained for TCRγδ (22%), CD66b (13%) and only rarely for CD4+, macrophage and NK cell markers. Conclusions TIA-1 adds prognostic information to TNM stage and adjuvant therapy in MMR-proficient colorectal cancer patients. The prognostic effect of CD8+ TILs is confounded by the presence of TIA-1+ which translates into improved risk stratification for approximately 35% of all patients with MMR-proficient colorectal cancers.
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Affiliation(s)
- Inti Zlobec
- Institute for Pathology, University of Basel, Basel, Switzerland.
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Abstract
The incidental finding of an isolated splenomegaly during clinical assessment of patients evaluated for unrelated causes has become increasingly frequent because of the widespread use of imaging. Therefore, the challenging approach to the differential diagnosis of spleen disorders has emerged as a rather common issue of clinical practice. A true diagnostic dilemma hides in distinguishing pathologic conditions primarily involving the spleen from those in which splenomegaly presents as an epiphenomenon of hepatic or systemic diseases. Among the causes of isolated splenomegaly, lymphoid malignancies account for a relevant, yet probably underestimated, number of cases. Splenic lymphomas constitute a wide and heterogeneous array of diseases, whose clinical behavior spans from indolent to highly aggressive. Such a clinical heterogeneity is paralleled by the high degree of biologic variation in the lymphoid populations from which they originate. Nevertheless, the presenting clinical, laboratory, and pathologic features of these diseases often display significant overlaps. In this manuscript, we present our approach to the diagnosis and treatment of these rare lymphomas, whose complexity has been so far determined by the lack of prospectively validated prognostic systems, treatment strategies, and response criteria.
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Chang ST, Hsieh YC, Chen CH, Tsao CJ, Chuang SS. T-cell large granular lymphocytic leukemia with pleomorphic nuclei and colonic infiltration with chronic diarrhea. Leuk Lymphoma 2010; 51:2132-4. [DOI: 10.3109/10428194.2010.517280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Meyerson HJ. A practical approach to the flow cytometric detection and diagnosis of T-cell lymphoproliferative disorders. ACTA ACUST UNITED AC 2010; 16:32-52. [PMID: 20858587 DOI: 10.1532/lh96.10001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The flow cytometric analysis of T-cell malignancies is difficult due to the heterogeneity of T-cells and the lack of convenient methods to detect T-cell clonality. Neoplastic T-cells are most often detected by their altered level of surface antigen expression, and detection requires an extensive knowledge of the phenotype of normal T-lymphocytes. This review focuses on the methods to distinguish malignant T-cells from their normal counterparts and the phenotypic features of the T-cell lymphoproliferative disorders.
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Affiliation(s)
- Howard J Meyerson
- Department of Pathology and Ireland Cancer Center of Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio 44106 , USA.
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Kwong YL, Au WY, Leung AYH, Tse EWC. T-cell large granular lymphocyte leukemia: an Asian perspective. Ann Hematol 2010; 89:331-9. [PMID: 20084380 PMCID: PMC7102052 DOI: 10.1007/s00277-009-0895-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 12/22/2009] [Indexed: 11/24/2022]
Abstract
To characterize T-cell large granular leukemia in Asia, 22 Chinese patients from a single institute were reported, together with an analysis of 88 Asian and 272 Western patients identified from the literature. In our cohort, anemia due to pure red cell aplasia (PRCA) occurred in 15/22 (68%) of cases, being the most common indication for treatment. Neutropenia was only found in 8/22 (36%) cases, and recurrent infections, the most important clinical problem in Western patients, were not observed. None of our cases presented with rheumatoid arthritis. These clinical features were consistently observed when compared with the 88 other Asian patients. Combined data from our cohort and other Asian cases showed that Asian patients, compared with Western patients, had more frequent anemia (66/110, 60% versus 113/240, 47%; p=0.044), attributable to a much higher incidence of PRCA (52/110, 47% versus 6/143, 4%; p<0.001). However, Western patients presented more frequently than Asian patients with neutropenia (146/235, 62% versus 33/110, 30%; p<0.001) and splenomegaly (99/246, 40% versus 16/110, 15%; p< 0.001). Notably, Western patients were about eight to ten times more likely than Asian patients to have rheumatoid arthritis (73/272, 27% versus 4/106, 4%; p<0.001) and recurrent infections (81/272, 30% versus 3/107, 3%; p<0.001). These clinicopathologic differences have important implications on disease pathogenesis and treatment.
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Affiliation(s)
- Yok-Lam Kwong
- Department of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China.
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Shah A, Diehl LF, St Clair EW. T cell large granular lymphocyte leukemia associated with rheumatoid arthritis and neutropenia. Clin Immunol 2009; 132:145-52. [PMID: 19394280 DOI: 10.1016/j.clim.2009.03.515] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 03/15/2009] [Indexed: 12/22/2022]
Abstract
T cell large granular lymphocyte leukemia (T-LGL) is a disease characterized by clonal expansion of cytotoxic T cells (CTLs). It generally follows an indolent course and is notable for an association with chronic inflammation, neutropenia and rheumatoid arthritis (RA). We present herein a case of a patient with rheumatoid arthritis (RA), neutropenia, large granular lymphocytosis, and an expanded clonal population of peripheral blood CD3(+)CD8(+)TCRalphabeta CTLs, consistent with the diagnosis of T-LGL. T-LGL is part of a spectrum of large granular lymphocytic (LGL) disorders, which includes the more common indolent variety of this disease (as illustrated by the case herein), an aggressive but rare form of this leukemia, natural killer (NK) cell LGL leukemia, Felty's syndrome (FS), and chronic large granular lymphocytosis. T-LGL appears to be a relatively rare disease, but the true prevalence is not known. FS occurs in less than 1% of patients with RA and is typically defined by the triad of destructive arthritis, neutropenia, and variable splenomegaly. A subset of patients with FS will demonstrate polyclonal expansion of LGLs, implying a relationship between proliferation of LGLs and the mechanisms of neutropenia. Thus, T-LGL leukemia and FS with LGL expansion in the setting of RA is classically distinguished by the clonality of the CTL population, with monoclonality in T-LGL and polyclonality in FS. Despite this difference, T-LGL and FS are often similar in their clinical and biological behavior. Both may respond to immunosuppressive therapy, and pursue a smoldering course typical of a chronic inflammatory disease.
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Affiliation(s)
- Ankoor Shah
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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47
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Abstract
Mature T- and natural killer (NK)-cell neoplasms are relatively rare forms of leukemia/lymphoma. The diagnosis of these entities is often difficult, necessitating extensive immunophenotypic, molecular, and genetic testing. Despite the accumulating information on the pathobiology of these neoplasms, in many cases the prognosis remains poor. This article presents an updated view of the morphologic, immunophenotypic, genetic, and molecular characteristics of the mature T- and NK-cell neoplasms. For a better understanding of this complex topic, the development of normal T and NK cells is briefly discussed. The presentation of the characteristic features of the neoplasms in the 2008 World Health Organization classification of hematopoietic neoplasms includes advances in the understanding of the pathobiology of each diagnostic category.
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Affiliation(s)
- Claudiu V Cotta
- Hematopathology Section, Pathology and Laboratory Medicine Institute, Cleveland Clinic, OH 44195, USA.
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48
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Robak T. Treatment of chronic lymphoid leukemias with monoclonal antibodies: current place and perspectives. Drug Dev Res 2008. [DOI: 10.1002/ddr.20269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Olteanu H, Karandikar NJ, Eshoa C, Kroft SH. Laboratory findings in CD4(+) large granular lymphocytoses. Int J Lab Hematol 2008; 32:e9-16. [PMID: 20089001 DOI: 10.1111/j.1751-553x.2008.01109.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Large granular lymphocytic (LGL) leukemia is an uncommon disorder of mature T or natural killer (NK) cells. Most T-LGL proliferations are CD3(+)/CD8(+), although rare CD4(+) clonal T-LGL expansions have been reported. We report the clinicopathologic features of eight patients with aberrant CD4(+), cytotoxic T-cell lymphocytoses. Median follow-up was 29 months (range 8-100), during which all were alive without requirement for therapy. Four of eight patients had an additional malignancy; none had a history of rheumatoid arthritis, lymphadenopathy or hepatosplenomegaly. Morphologic expansions of granulated lymphocytes were evident in 6/8. All had immunophenotypically aberrant populations of CD4(+) T cells with uniform, moderate or bright CD56. Seven of eight expressed CD57, and four were CD8(partial dim +). Abnormal levels of expression of two or more T-cell antigens were seen in all cases. All tested cases were Tgamma PCR positive. Our results support that CD4(+) T-LGL lymphocytosis is a clonal disorder with clinicopathologic characteristics distinct from the more common CD8(+) variant.
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Affiliation(s)
- H Olteanu
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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50
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Shaw GR, Naik VS. The gammadelta variant of T cell large granular lymphocyte leukemia is very similar to the common alphabeta type: report of two cases. J Hematop 2008; 1:139-43. [PMID: 19669213 PMCID: PMC2713487 DOI: 10.1007/s12308-008-0016-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Accepted: 07/28/2008] [Indexed: 02/02/2023] Open
Abstract
The vast majority of cases of T cell large granular lymphocyte (T-LGL) leukemia have a CD3+, CD4-, CD8+ phenotype and express the alphabeta T cell receptor. Whether the rare gammadelta variant should be included in the same diagnostic category is currently unclear. Two well-characterized cases of gammadelta T-LGL leukemia were identified by our laboratory in 2007. These two cases and other reports of gammadelta T-LGL leukemia were compared with the common alphabeta variant. Other than more often being negative for both CD4 and CD8 (in about 35% to 40% of cases), the gammadelta variant of T-LGL leukemia is similar to the common alphabeta type in virtually all respects and should be included in the general category of T-LGL leukemia. However, it is important to exclude other more aggressive gammadelta T cell lymphoproliferative disorders.
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Affiliation(s)
- Gene R Shaw
- Department of Pathology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI, 54449, USA,
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