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. 2010 Sep;95(9):1534-41.
doi: 10.3324/haematol.2009.018481. Epub 2010 Apr 7.

Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases

Benoît Bareau  1 , Jérôme Rey, Mohamed Hamidou, Jean Donadieu, Jeff Morcet, Oumedaly Reman, Nicolas Schleinitz, Olivier Tournilhac, Mikael Roussel, Thierry Fest, Thierry Lamy
Affiliations

Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases

Benoît Bareau et al. Haematologica. 2010 Sep.

Abstract

Background: Large granular lymphocyte leukemia is a rare lymphoproliferative disorder associated with autoimmune diseases and impaired hematopoiesis. This study describes the clinical and biological characteristics of 229 patients with T-cell or NK-cell large granular lymphocyte leukemia.

Design and methods: The diagnosis was based on a large granular lymphocyte expansion (> 0.5x10(9)/L) lasting more than 6 months. Monoclonal T-cell receptor gamma gene rearrangement was detected in all the cases of T-cell large granular lymphocyte leukemia. Patients with chronic NK-cell lymphocytosis had an indolent disease, while those with multiorgan large granular lymphocyte infiltration and an aggressive clinical disease were considered to have NK-cell large granular lymphocyte leukemia.

Results: The diagnosis of T-cell large granular lymphocyte leukemia was confirmed in 201 cases, chronic NK-cell lymphocytosis in 27 cases and NK-cell large granular lymphocyte leukemia in one case. Associated autoimmune diseases or other neoplasms were present in 74 and 32 cases, respectively. One hundred patients (44%) required treatment, mainly for neutropenia-associated infections (n=45), symptomatic autoimmune diseases (n =24), transfusion-dependant anemia (n=18), and other causes (n=13). Patients were treated with steroids (n= 33), methotrexate (n=62), cytoxan (n=32), or cyclosporine (n=24) either as first-, second-, third- or fourth-line therapy. The overall response rate at 3 months and complete response rate for the various treatments were as follows: steroids (12% and 3%), methotrexate (55% and 21%), cytoxan (66% and 47%), cyclosporine (21% and 4%), respectively. Four out of 13 patients responded to splenectomy. Eleven out of 15 patients responded to cytoxan after methotrexate treatment had failed. The mean number of treatments was 3.4 (range, 1-7). There were 15 large granular lymphocyte leukemia-related deaths.

Conclusions: Patients with T-cell large granular lymphocyte leukemia and chronic NK-cell lymphocytosis have similar clinical and biological features and responses to treatment. First-line therapy with cytoxan should be tested in a prospective trial.

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Figures

Figure 1.
Figure 1.
Vβ CMF analysis in T-LGL leukemia showing the Vβ subsets expressed in more than one case (n=43).
Figure 2.
Figure 2.
Algorithm of treatment outcome for 70 patients with T- or NK-LGL leukemia.
Figure 3.
Figure 3.
Overall survival of the 228 patients (the patient with the aggressive form of NK-LGL leukemia was excluded).
See this image and copyright information in PMC

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