Cyclophosphamide as a first-line therapy in LGL leukemia

Abstract

International audienceLetter to the Editor. Large granular lymphocyte (LGL) leukemia is a T or NK clonal disorder characterized by the tissue invasion of marrow, spleen and liver..

The analysis of clonal diversity and therapy responses using STAT3 mutations as a molecular marker in large granular lymphocytic leukemia

“…Concordantly, recent results support the use of cyclophosphamide as a first-line therapy: the overall response rate was 71% (complete response 47%) and relapses were rarely observed. 39 Low relapse rates could be related to the ability of cyclophosphamide to eradicate LGL clones, but further studies with larger patient cohorts are needed to confirm the preliminary findings.…”

How we evaluate and treat neutropenia in adults

“…57,58 Interestingly, despite the fact that it is a T cell-mediated disease, autoimmune neutropenia may also respond to rituximab. 59 Most patients will also respond to G-CSF, although in the setting of RA, this may cause an acute exacerbation of joint symptoms.…”

Mature T-cell leukemias: Molecular and Clinical Aspects

“…Methotrexate is also a possible frontline therapy in patients without associated autoimmunity, as are cyclosporine A and cyclophosphamide [32,43]. Patients treated with methotrexate frequently relapse [30], and recent retrospective data suggest that cyclophosphamide may have better efficacy, generating durable responses in many T-LGLL patients [43]. Though the number of patients studied is limited, complete molecular responses (as judged by STAT3 mutation detection) may be more common in cyclophosphamide-treated patients than in those treated with methotrexate [38].…”

“…In patients with autoimmune disease, a common therapeutic approach is methotrexate with or without steroids [32]. Methotrexate is also a possible frontline therapy in patients without associated autoimmunity, as are cyclosporine A and cyclophosphamide [32,43]. Patients treated with methotrexate frequently relapse [30], and recent retrospective data suggest that cyclophosphamide may have better efficacy, generating durable responses in many T-LGLL patients [43].…”