Large granular lymphocyte (LGL) proliferation typically follows a chronic course during which major features are cytopenia and immune abnormalities. Elevated numbers of LGL were reported in a few cases following allogeneic stem cell transplantation (allo-SCT). In this report, we present a retrospective analysis of LGL cases that occurred following allo-SCT in a cohort of 201 consecutive patients transplanted over a period of 7 years. Six cases were identified and LGL expansion occurred more frequently following a reduced fludarabine and anti-T lymphocyte globulin-based preparative regimen (4 cases/49), than after a conventional myeloablative regimen (2 cases/152). Expansion of LGL was seen between 3 and 15 months following allo-SCT. Hematopoiesis, with mild to severe cytopenia, was a favored target for LGL. Autoimmune manifestations including polyarthritis and hypergammaglobulinemia were also observed. LGL proliferation was observed in the context of chronic antigenic stimulation associated with recurrent viral infections especially CMV. Moreover, five out of these six high risk patients achieved a long-term complete remission concomitant or following LGL expansion. These data suggest that LGL might be a subset of effector lymphocytes which may participate to the graft-versus-tumor effect.

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Summary:Case reportA 38-year-old man (blood group A+; phenotype A 38-year-old man, blood group A+, was allotransplanted for multiple myeloma from his fully matched D+C+E−c+e+K−) was allotransplanted for multiple myeloma from his fully HLA-matched sister (blood group O+, sister, blood group O+. Anti-A antibodies IgG and IgM titres of the donor were low. Allogeneic peripheral blood phenotype D+C−E−c+e+K−). Recipient and donor ABO groups were determined twice using RBC grouping test and stem cells were harvested by leukapheresis after subcutaneous administration of G-CSF. Rapid serum grouping test. No unexpected alloantibody was identified. Anti-A antibodies IgG and IgM titres of the engraftment occurred since 5.6 × 10 9 /l leukocytes were achieved on day +9 post-transplant. At this time a sevdonor were low (both 1/8). Allogeneic peripheral blood stem cells were harvested by leukapheresis after subcutaneere immune haemolytic syndrome occurred and direct antiglobulin test was positive (IgG and C3d). Elution ous administration of G-CSF (granocyte, kindly provided by Bellon, Neuilly, France) (CD34 + 3.5 × 10 6 /kg; CD3 + showed an anti-A specificity. Evolution was rapidly unfavourable related to multiorgan failure. The patient 410 × 10 6 /kg; CD19 + 79 × 10 6 /kg). The conditioning regimen consisted of cyclophosphamide (60 mg/kg) and TBI; died on day +20 post-transplant. Keywords: ABO incompatibility; allogeneic peripheral prevention of GVHD was provided by cyclosporin A (CsA) and methylprednisolone. No deplasmatisation of the blood stem cell transplantation APBSC was performed since anti-A antibody titre of the donor was low. Rapid engraftment occurred since 500/mm 3 and 5600/mm 3 leukocytes were achieved on day +8 and +9, Allogeneic bone marrow transplantation can be successrespectively. Two transfusions of phenotyped and irradiated fully performed despite ABO incompatibility between the A+ RBC and one irradiated platelet transfusion of group donor and recipient. Major incompatibility may cause a A+ were given to the patient on day +7 when Hb was severe haemolytic transfusion reaction at the time of BMT 7.1 g/dl and platelet counts were 6000/mm 3 . On day +9, a due to interaction of donor type RBC with pre-existing severe immune haemolytic syndrome occurred: acute anehost-derived isohaemagglutins. This complication can be mia, backpain, elevation of bilirubin, LDH and serum prevented easily by removing RBC from the marrow graft.creatinin. Direct antiglobulin test was positive (IgG and On the other hand minor incompatibility, where donorC3d) (Figure 1). Serum testing showed the presence of antiderived antibodies are directed against ABO antigens of the A alloantibodies. The saline indirect antiglobulin test recipient erythrocytes, may lead to delayed immune haeshowed an anti-A specificity and elution in LISS (low ionic molysis caused by transient antibody production from strength saline) solution revealed strong reactivity anti-A donor immunocompetent lymphocytes. This complication (++++). Group O RBC with original r...