Large granular lymphocytosis after transplantation

Abstract

Post-transplant lymphoproliferative disorders (PTLD) represent a heterogeneous group of diseases that occur following transplantation. Large granular lymphocytic (LGL) lymphocytosis is one type of PTLD, ranging from reactive polyclonal selflimited expansion to oligo/monoclonal lymphocytosis or even to overt leukaemia.LGL lymphocytosis in transplant recipients may present as a relatively indolent version of the condition and may be more common than reported, but its natural history and clinical course have not been well described, and the lack of a reliable classification system has limited studies on this disease. Patients with unexplained cytopenias, autoimmune manifestations, or unexpected remissions may be mislabelled. The purpose of this review was to evaluate the clinical features, immunophenotypes, etiopathogenesis, diagnosis, outcomes and treatment of post-transplantation LGL lymphocytosis. In conclusion, LGL lymphocytosis is a frequent occurrence after transplantation that correlates with certain procedural variables and post-transplant events. LGL lymphocytosis should be considered in patients with unexplained lymphocytosis or when pancytopenia develops after transplantation. The diagnosis of LGL lymphocytosis requires a demonstration of monoclonality, but clonality does not indicate malignancy. Additional studies are necessary to further delineate the potential effects of large granular lymphocytes in the long-term prognosis of posttransplant patients.

Single-cell RNA sequencing coupled to TCR profiling of large granular lymphocyte leukemia T cells

“…In our samples, these motifs of HLA-A*0201, CMV + CDR3s were more represented in expanded clones of CMV + subjects than in CMV − cases (Fisher test; P = 0.033). These results added to validity of our current analysis and to a hypothesis that chronic CMV antigen stimulation is a potential driver of T cell clonal expansion 33 .…”

Large granular lymphocytic leukaemia after solid organ and haematopoietic stem cell transplantation

“…Several mechanisms of clonal expansion post‐transplantation may be responsible, including active viral infections, latent oncogenic viral reactivation, graft allo‐antigenic stimulation or reactivation of a pre‐existing autoimmune process (Fig ). In general, although oligoclonal skewing has been described after transplantation (Gorochov et al , ; Mohty et al , ; Sabnani et al , ; Qiu et al , ), the vast majority of patients with this complication is not known to develop T‐LGLL. Theoretically, T‐LGLL may originate from pre transplantation autoimmunity of the donor in HSCT or recipient in SOT, which has been augmented by a heightened level of immune responsiveness due to allo‐stimulation.…”

Autoimmune Cytopenias Developing Late Post Alemtuzumab-Based Allogeneic Stem Cell Transplantation: Presentation of Short Case Series from a Transplant Center

“…It has been observed that LGL is often associated with chronic CMV infection as well as patients with chronic GvHD through a process of chronic antigenic stimulation. LGL is a phenomenon estimated to affect between 0.5% and 18.4% of patients following HSCT 11 . The presentations can range from self-limiting polyclonal expansion to overt leukemia.…”