T-cell large granular lymphocytic leukemia occurring after autologous peripheral blood stem cell transplantation

Abstract

Summary:A 61-year-old man with angioimmunoblastic lymphoma in first complete remission underwent autologous peripheral blood stem cell transplantation. At 1 month post transplant, asymptomatic large granular lymphocytosis developed. The surface marker profile of the cells was CD3 þ CD8 þ CD56ÀCD57 þ . The disease course was chronic and indolent. The patient remains in complete remission from angioimmunoblastic lymphoma more than 6 months post transplant with persistent large granular lymphocytosis (lymphocyte count, 5-15 Â 10 9 /l). Although post transplantation T-cell lymphoproliferative disorders have mostly occurred in allogeneic transplantation recipients and presented as aggressive lymphomas/leukemias, we suggest that chronic indolent T-cell large granular lymphocytic leukemia can occur after autologous stem cell transplantation. Bone Marrow Transplantation (2004) 33, 99-101. doi:10.1038/sj.bmt.1704298 Keywords: T-cell large granular lymphocytic leukemia; post transplantation lymphoproliferative disorders; autologous peripheral blood stem cell transplantation T-cell large granular lymphocytic (T-LGL) leukemia is a lymphoproliferative disease derived from post-thymic immunocompetent T lymphocytes. 1 Large granular cell morphology, CD3 þ CD56ÀCD57 þ immunophenotype and the clonal rearrangement of T-cell receptor genes characterize T-LGL leukemia, which presents clinically with a chronic indolent disease course, complicated by frequent infections secondary to neutropenia.Post transplantation lymphoproliferative disorders (PTLD) are a well-recognized complication of solid organ and allogeneic bone marrow transplantation, and accumulating data have suggested that aggressive immunosuppression is closely associated with an increased risk of PTLD. 2,3 The majority of PTLD are of B-cell origin and are associated with active infection with Epstein-Barr virus (EBV). T-cell PTLD are much less common but, similar to B-cell PTLD, they mostly present as aggressive lymphomas following a rapidly fatal course. 4,5 EBV is infrequently involved in the pathogenesis. Autologous stem cell transplantation (ASCT) is another transplantation procedure. In spite of the profound myelosuppression associated with autografting, this procedure is inherently less immunosuppressive than allogeneic bone marrow transplantation and we were able to find less than 20 cases in the English literature describing PTLD following ASCT. 6-8 Here, we report the first case of chronic T-LGL leukemia following ASCT for angioimmunoblastic lymphoma. Case reportA 61-year-old man was admitted to our hospital in April 1997 because of fever, skin rash, edema, generalized lymphadenopathy and hemolysis. On physical examination, there was a maculo-papular rash on the trunk and extremities, and superficial lymphadenopathy was found in various regions including the neck, axilla and groin. A left pleural effusion and moderate splenomegaly (20 mm on the left midclavicular line) were also noted. The hemoglobin (Hb) was 8.1 g/dl, white blood cell count (WBC) 9.1 Â 10 9 /l...

Expansion of a Clonal CD8+CD57+ Large Granular Lymphocyte Population After Autologous Stem Cell Transplant in Multiple Myeloma

“…In these allogeneic transplant patients, the driving force of the large granular lymphocyte (LGL) expansion was thought to be foreign antigen exposure from the grafts. Interestingly, an increased proportion of LGLs has also been reported in peripheral blood following autologous stem cell transplant, [5][6][7][8] in which the allogeneic foreign antigen is not present. In 2 cases following autologous stem cell transplant, T-cell LGL leukemia was reported, and the LGL expansion was considered a posttransplant lymphoproliferative malignancy, 5,8 whereas in 1 case the expansion was considered a reactive process against the patient's tumor cells.…”

T-cell post-transplant lymphoproliferative disorder after hematopoietic stem cell transplantation: another case and a review of the literature

“…HIV, CMV and EBV as possible etiologic agents, whereas others have also excluded human T-cell lymphotropic virus type I. 4 The present case of PTLD has a T-LGL phenotype. Expanded oligoclonal and even monoclonal populations of cytotoxic T cells have been detected in PB of patients with MM and smouldering myeloma.…”

“…2 Recently, two cases of T-cell PTLD following autologous HSCT were described. 3,4 We report another case of T-cell PTLD after autologous HSCT in a patient with nonsecretory multiple myeloma (MM).…”

T-cell post-transplant lymphoproliferative disorder in a patient with chronic idiopathic myelofibrosis following allogeneic PBSC transplantation

“…There are only three reported cases of T-cell PTLD following allogeneic HSCT 3 and four cases following autologous HSCT. [4][5][6][7] Here we report a case of T-cell PTLD after allogeneic-PBSC transplantation (allo-PBSCT) in a patient with chronic idiopathic myelofibrosis (CIMF).…”