Chronic T cell lymphocytosis: a review of 21 cases

Abstract

Twenty-one patients are described with a proliferation of morphologically mature T lymphocytes. The clinical course was chronic in most, and splenic enlargement the main clinical finding; skin involvement and lymphadenopathy were rare. The mean lymphocyte count at presentation was 8 X 10(9)/1 (range 0.75-24 X 10(9)/1). Nineteen of these patients showed some form of cytopenia (18 neutropenia, two red cell aplasia, eight thrombocytopenia) and one had hypogammaglobulinaemia. Seven patients had long-standing arthropathy serologically proven to be rheumatoid arthritis and these had previously been considered to have Felty's syndrome. Five of the group have died (three with an aggressive course), but most have remained stable for prolonged periods with a slow increase in peripheral lymphocyte count and marrow infiltration. Spontaneous regression was never observed but in two patients a prolonged remission was achieved by chemotherapy. The lymphocytes were morphologically and phenotypically homogeneous at presentation and remained so post-splenectomy; they contained azurophilic granules, stained with acid phosphatase but weakly or not at all with alpha napthyl acetate esterase. Membrane phenotyping shows the majority of the cells to be E+, Fc gamma+, OKT3+, OKT8+. Most cells do not stain with OKT1-like reagents and a significant number express HLA-Dr. From these and other reported cases it is clear that this condition represents a distinct entity resulting from the expansion of a subset of cytotoxic/suppressor T cells--the question of the benign or neoplastic nature of the disease remains open. Using T cell-specific antisera and E-rosetting techniques, a small percentage of CLL cases have been shown to be of T-cell origin (TCLL) (Dickler et al, 1973; Lille et al, 1973). Estimates of the percentage vary but in most series T-CLL has been diagnosed in less than 5% (Brouet & Seligmann, 1981), and this is supported by date from the M.R.C. Leukaemia Unit which found T-CLL in only 1.5% of 600 cases of CLL examined by marker studies (D. Catovsky, unpublished). Amongst the published reports of T-CLL a variety of clinical and morphological entities have been described including T prolymphocytic leukaemia (TPLL) (Brouet et al. 1975) and adult T cell disease in Japanese (Uchiyama et al, 1977) and West Indian Caribbean groups (ATLL) (Catovsky et al, 1982). In the original series of Brouet & Seligmann (1981) the group was defined as presenting in middle age with marked hepatosplenomegaly, some lymphadenopathy, skin involvement and with an aggressive disease course; peripheral blood and marrow lymphocytosis were variable.(ABSTRACT TRUNCATED AT 400 WORDS)

T-Cell Large Granular Lymphocyte Leukemia and Related Disorders

“…Rare spontaneous remissions have been reported [82,83]. However, the majority of patients require treatment at some point in their disease [9,11,12,15,18,84].…”

“…Males and females are affected equally. Approximately half the patients are diagnosed because of recurrent bacterial infections secondary to neutropenia, which typically include cellulitis, perirectal abscesses, or respiratory infections [8][9][10][11][12][13][14][15][16].…”

Chronic leukemias

“…In Newland's series, three of 21 LGLL patients died of disease progression. 55 In Loughran's series, median survival was 17 months (range, one to 36 months). 56 In another large series, 13 percent of the patients died of progressive disease within four years.…”

Cyclophosphamide therapy for pure red cell aplasia associated with granular lymphocyte‐proliferative disorders

“…Cyclophosphamide was also effective for the neutropenia of patients 2, 3, 4 and 6. Neutropenia is seen in more than half of the patients with GLPD (Gastl et al, 1986;Newland et al, 1984;Reynolds & Foon, 1984), but the mechanism of neutropenia is not completely understood. Inhibition at the progenitor level seems unlikely, because, in our patients, neutrophils in the marrow were normal or rather hyperplastic.…”

“…The demonstration of an immune pathogenesis of the anaemia accompanying GLPD has provided a rationale for treatment with immunosuppressive agents (Lacy et al, 1996), and remissions have been achieved by treatment with corticosteroids (Newland et al, 1984;Partanen et al, 1984;Tefferi et al, 1989) and cytotoxic drugs (Akard et al, 1987;Hocking et al, 1983;Levitt et al, 1988). The relative effectiveness of various forms of therapy for pure red cell aplasia is not known, because it is difficult to determine the number of treatment failures with any particular programme.…”