1
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Assmann JL, Vlachonikola E, Kolijn PM, Agathangelidis A, Pechlivanis N, Papalexandri A, Stamatopoulos K, Chatzidimitriou A, Langerak AW. Context-dependent T-cell Receptor Gene Repertoire Profiles in Proliferations of T Large Granular Lymphocytes. Hemasphere 2023; 7:e929. [PMID: 37469801 PMCID: PMC10353713 DOI: 10.1097/hs9.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
T cell large granular lymphocyte (T-LGL) lymphoproliferations constitute a disease spectrum ranging from poly/oligo to monoclonal. Boundaries within this spectrum of proliferations are not well established. T-LGL lymphoproliferations co-occur with a wide variety of other diseases ranging from autoimmune disorders, solid tumors, hematological malignancies, post solid organ, and hematopoietic stem cell transplantation, and can therefore arise as a consequence of a wide variety of antigenic triggers. Persistence of a dominant malignant T-LGL clone is established through continuous STAT3 activation. Using next-generation sequencing, we profiled a cohort of 27 well-established patients with T-LGL lymphoproliferations, aiming to identify the subclonal architecture of the T-cell receptor beta (TRB) chain gene repertoire. Moreover, we searched for associations between TRB gene repertoire patterns and clinical manifestations, with the ultimate objective of discriminating between T-LGL lymphoproliferations developing in different clinical contexts and/or displaying distinct clinical presentation. Altogether, our data demonstrates that the TRB gene repertoire of patients with T-LGL lymphoproliferations is context-dependent, displaying distinct clonal architectures in different settings. Our results also highlight that there are monoclonal T-LGL cells with or without STAT3 mutations that cause symptoms such as neutropenia on one end of a spectrum and reactive oligoclonal T-LGL lymphoproliferations on the other. Longitudinal analysis revealed temporal clonal dynamics and showed that T-LGL cells might arise as an epiphenomenon when co-occurring with other malignancies, possibly reactive toward tumor antigens.
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Affiliation(s)
- Jorn L.J.C. Assmann
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, Netherlands
| | | | - Pieter M. Kolijn
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, Netherlands
| | | | - Nikolaos Pechlivanis
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Greece
| | | | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Greece
| | | | - Anton W. Langerak
- Laboratory for Medical Immunology, Department of Immunology, Erasmus MC, Rotterdam, Netherlands
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2
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Gamma Heavy Chain Disease Associated with T-Cell Large Granular Lymphocyte Lymphoproliferative Disorder: Case Report and Literature Review. Mediterr J Hematol Infect Dis 2023; 15:e2023010. [PMID: 36660354 PMCID: PMC9833300 DOI: 10.4084/mjhid.2023.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
Heavy chain diseases are rare B-cell neoplasms consisting of the production of a monoclonal immunoglobulin composed of the only heavy chain without corresponding light chains. It is a rare adult disease that may involve several sites with a variable clinical course. It manifests itself on a large spectrum from indolent to rapidly progressive. We present a case of heavy chain disease and concomitant T- cell large granular lymphoproliferative disorder, an association described in only six cases before.
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3
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Xu Q, Yu J, Lin X, Li Y, Zhang K. CB-LPD, MGUS, T-LGLL, and PRCA: A rare case report of 4 concomitant hematological disorders. Medicine (Baltimore) 2021; 100:e27874. [PMID: 34964755 PMCID: PMC8615434 DOI: 10.1097/md.0000000000027874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Monoclonal gammopathy of undetermined significance (MGUS) is a clinically asymptomatic clonal plasma cell or lymphoplasmacytic proliferative disorder. Recently, some case reports have described the association of pure red cell aplasia (PRCA) with MGUS, even with a relatively low monoclonal immunoglobulin burden. T large granular lymphocyte leukemia (T-LGLL) is a chronic lymphoproliferative disorder characterized by clonal expansion of T large granular lymphocytes, which is rare in China. There are some reports about T-LGL leukemia in patients with B-cell lymphoma; however, it is very rare that T-LGLL coexists with MGUS and clonal B-cell lymphoproliferative disorders (CB-LPD). PATIENT CONCERNS A 77-year-old man was hospitalized because of anemia. He was diagnosed with MGUS, CB-LPD, and PRCA. During the development of the disease, a group of abnormal T lymphocytes was detected by flow cytometry of peripheral blood. DIAGNOSIS Combining clinical manifestations with the result of T cell receptor gene rearrangement and immunophenotype, it was consistent with the diagnosis of T large granular lymphocyte leukemia. INTERVENTIONS The patient was treat with bortezomib and dexamethasone regimen, Rituximab and sirolimus. OUTCOMES The patient was transfusion independent after therapies. LESSONS We report a patient with 4 concomitant hematological disorders: T-LGLL, MGUS, CB-LPD, and PRCA, aiming to represent the clinical and flow cytometry characteristics of these concomitant diseases, analyze the mechanism between diseases, and provide a clinical reference.
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Affiliation(s)
- Qinhong Xu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Jieni Yu
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Xiaoyan Lin
- The Center of Clinical Laboratory, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Youli Li
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
| | - Kejie Zhang
- Department of Hematology, Zhongshan Hospital, Xiamen University, Fujian Medical University Clinic Teaching Hospital, Xiamen, Fujian, China
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4
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Papalexandri A, Karypidou M, Stalika E, Kotta K, Touloumenidou T, Zerva P, Paleta A, Mallouri D, Batsis I, Sakellari I, Kotsianidis I, Anagnostopoulos A, Hadzidimitriou A, Margaritis D, Stamatopoulos K. Skewing of the T-cell receptor repertoire in patients receiving rituximab after allogeneic hematopoietic cell transplantation: what lies beneath? Leuk Lymphoma 2019; 60:1685-1692. [PMID: 30652530 DOI: 10.1080/10428194.2018.1543881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rituximab is known to affect T cell immune responses. We and others have reported expansions of T large granular lymphocytes (T-LGLs) in lymphoma patients after Rituximab. We report here the immunogenetic profiling of the T cell receptor (TR) gene repertoire in 14 patients who received Rituximab post allo-HCT and explore clinicobiological correlations. All experienced antigenic triggers, CMV, EBV re-activation and chronic GvHD and had been treated with Rituximab. Skewing of TRBV genes was observed: 3 TRBV genes accounted for half of the repertoire. Oligoclonal pattern with expanded clonotypes was common. Patients with oligoclonality exhibited frequently cGvHD. Longitudinal samples in one revealed distinct clonotypes, suggesting clonal drift. T-LGL leukemia of donor origin with mixed chimerism eventually developed. In conclusion, we report development of oligoclonal T-LGLs after Rituximab post allo-HCT, alluding to antigen selection. Persistence of this phenomenon likely reflects strong antigenic stimulation by viruses and/or cGVHD aggravated by Rituximab.
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Affiliation(s)
- Apostolia Papalexandri
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece.,b Hematology Department, School of Health Sciences , Democritus University of Thrace , Alexandropouli , Greece
| | - Maria Karypidou
- c Institute of Applied Biosciences, Centre for Research and Technology Hellas , Thessaloniki , Greece
| | - Evangelia Stalika
- c Institute of Applied Biosciences, Centre for Research and Technology Hellas , Thessaloniki , Greece
| | - Konstantina Kotta
- c Institute of Applied Biosciences, Centre for Research and Technology Hellas , Thessaloniki , Greece
| | - Tasoula Touloumenidou
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Panagiota Zerva
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Angeliki Paleta
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Despina Mallouri
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Batsis
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioanna Sakellari
- a Haematology Department and BMT Unit , G.Papanikolaou Hospital , Thessaloniki , Greece
| | - Ioannis Kotsianidis
- b Hematology Department, School of Health Sciences , Democritus University of Thrace , Alexandropouli , Greece
| | | | - Anastasia Hadzidimitriou
- c Institute of Applied Biosciences, Centre for Research and Technology Hellas , Thessaloniki , Greece
| | - Dimitris Margaritis
- b Hematology Department, School of Health Sciences , Democritus University of Thrace , Alexandropouli , Greece
| | - Kostas Stamatopoulos
- c Institute of Applied Biosciences, Centre for Research and Technology Hellas , Thessaloniki , Greece
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5
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Sun H, Wei S, Yang L. Dysfunction of immune system in the development of large granular lymphocyte leukemia. ACTA ACUST UNITED AC 2018; 24:139-147. [PMID: 30334691 DOI: 10.1080/10245332.2018.1535294] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Large granular lymphocyte (LGL) leukemia is a rare type of lymphoproliferative disease caused by clonal antigenic stimulation of T cells and natural killer (NK) cells. METHODS In this review, we focus on the current knowledge of the immunological dysfunctions associated with LGL leukemia and the associated disorders coexistent with this disease. Novel therapeutic options targeting known molecular mechanisms are also discussed. RESULTS AND DISCUSSION The pathogenesis of LGL leukemia involves the accumulation of gene mutations, dysregulated signaling pathways and immunological dysfunction. Mounting evidence indicated that dysregulated survival signaling pathways may be responsible for the immunological dysfunction in LGL leukemia including decreased numbers of neutrophils, dysregulated signal transduction of NK cells, abnormal B-cells, aberrant CD8+ T cells, as well as autoimmune and hematological abnormalities. CONCLUSION A better understanding of the immune dysregulation triggered by LGL leukemia will be beneficial to explore the pathogenesis and potential therapeutic targets for this disease.
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Affiliation(s)
- Houfang Sun
- a Department of Immunology , Tianjin Medical University Cancer Institute and Hospital , Tianjin , People's Republic of China.,b National Clinical Research Center of Cancer , People's Republic of China.,c Key Laboratory of Cancer Immunology and Biotherapy , Tianjin , People's Republic of China.,d Key Laboratory of Cancer Prevention and Therapy , Tianjin , People's Republic of China.,e Tianjin's Clinical Research Center for Cancer , Tianjin , People's Republic of China
| | - Sheng Wei
- f Immunology Program , The H. Lee Moffitt Cancer Center , Tampa , FL , USA
| | - Lili Yang
- a Department of Immunology , Tianjin Medical University Cancer Institute and Hospital , Tianjin , People's Republic of China.,b National Clinical Research Center of Cancer , People's Republic of China.,c Key Laboratory of Cancer Immunology and Biotherapy , Tianjin , People's Republic of China.,d Key Laboratory of Cancer Prevention and Therapy , Tianjin , People's Republic of China.,e Tianjin's Clinical Research Center for Cancer , Tianjin , People's Republic of China
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6
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De Luca G, Trasarti S, Bizzoni L, Del Giudice I, Della Starza I, De Propris MS, Gentile G, Mancini F, Mantovani S, Petrucci L, Tabanelli V, Guarini A, Vignetti M, Foà R. Lymphomatoid granulomatosis and large granular lymphocyte leukemia, a rare association of two lymphoproliferative disorders. Leuk Lymphoma 2018; 59:2715-2718. [PMID: 29473430 DOI: 10.1080/10428194.2018.1439583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Giulia De Luca
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Stefania Trasarti
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Luisa Bizzoni
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Ilaria Del Giudice
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Irene Della Starza
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Maria Stefania De Propris
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Giuseppe Gentile
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Francesca Mancini
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | | | - Luigi Petrucci
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | | | - Anna Guarini
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Marco Vignetti
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
| | - Robin Foà
- a Department of Hematology , Cellular Biotechnologies and Hematology, University of Rome , Rome , Italy
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7
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Goyal T, Thakral B, Wang SA, Bueso-Ramos CE, Shi M, Jevremovic D, Morice WG, Zhang QY, George TI, Foucar KK, Bhattacharyya S, Bagg A, Rogers HJ, Bodo J, Durkin L, Hsi ED. T-Cell Large Granular Lymphocytic Leukemia and Coexisting B-Cell Lymphomas: A Study From the Bone Marrow Pathology Group. Am J Clin Pathol 2018; 149:164-171. [PMID: 29365010 DOI: 10.1093/ajcp/aqx146] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE T-cell large granular lymphocytic (T-LGL) leukemia is associated with B-cell lymphomas (BCLs), especially small BCLs. We aimed to explore and expand upon its association with BCLs. METHODS We retrospectively studied clinicopathologic features of T-LGL leukemia patients with coexisting BCL from January 2001 to December 2016. RESULTS Among 432 patients with T-LGL leukemia, 22 (5.1%) had an associated B-cell non-Hodgkin lymphoma. Thirteen (59%) patients had large and nine (41%) had small BCL. T-LGL leukemia occurred synchronously with BCL in five, preceded BCL in three, and followed BCL in 14 patients. Anemia was the most common cytopenia (68%). Only one patient had a history of rheumatoid arthritis. CONCLUSION To our knowledge, this is the first multicenter study looking at the spectrum and incidence of BCLs in patients with T-LGL leukemia and highlights its association with large BCLs (3% of T-LGL leukemias).
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Affiliation(s)
| | | | - Sa A Wang
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | | | - Adam Bagg
- Hospital of the University of Pennsylvania, Philadelphia
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8
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Abstract
Large granular lymphocytes (LGLs) are large lymphocytes with azurophilic granules in their cytoplasm. LGLs are either natural killer (NK) cells or T lymphocytes. Expansions of the LGLs in the peripheral blood are seen in various conditions, including three clonal disorders: T-cell LGL (T-LGL) leukemia, chronic lymphoproliferative disorders of NK cells (CLPD-NK), and aggressive NK-cell leukemia (ANKL). However, the monoclonal and polyclonal expansion of LGLs has been associated with many other conditions. The present article describes these LGL disorders, with special emphasis on the clinical features, pathogenesis, and treatments of the three above-mentioned clonal disorders.
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Affiliation(s)
- Kazuo Oshimi
- Department of Medicine, Kushiro Rosai Hospital, Japan
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9
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Mahdi T, Rajab A, Padmore R, Porwit A. Characteristics of Lymphoproliferative Disorders with More Than One Aberrant Cell Population as Detected by 10-Color Flow Cytometry. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:230-238. [DOI: 10.1002/cyto.b.21402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/06/2016] [Accepted: 07/14/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Talal Mahdi
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Amr Rajab
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
| | - Ruth Padmore
- Department of Pathology and Laboratory Medicine; the Ottawa Hospital and Eastern Ontario Regional Laboratory Association and University of Ottawa; ON Canada
| | - Anna Porwit
- Department of Laboratory Hematology, Flow Cytometry Laboratory, Laboratory Medicine Program; University Health Network; Toronto ON Canada
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10
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Disseminated Gastric MALT Lymphoma with Monoclonal Gammopathy, t(11;18)(q21;q21), and Subsequent Development of T-Large Granular Lymphocytic Leukemia: A Case Report and Review of the Literature. Case Rep Med 2015; 2015:953297. [PMID: 26064133 PMCID: PMC4438148 DOI: 10.1155/2015/953297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 04/22/2015] [Indexed: 02/07/2023] Open
Abstract
Background. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) is a well-characterized entity that may share clinical and morphological findings with other low-grade non-Hodgkin's lymphomas. Dissemination of MALT-type lymphoma to bone marrow and peripheral blood simultaneously with the presence of T-large granular cell leukemia (T-LGL) has rarely been reported. Case Presentation. This is the case of a 42-year-old male who presented with a gastric MALT-type lymphoma, disseminated to the bone marrow and the peripheral blood with high serum IgM levels and t(11;18)(q21;q21). The morphological, immunophenotypical and, immunohistochemical studies of the successive bone marrow and peripheral blood samples had revealed the coexistence of two distinct lymphoma cell populations: a B-cell, marginal zone type population expressing CD19, CD20, CD22, CD79b, IgM, and kappa light chain, and a T-large granular cell population, developed after treatment with rituximab expressing CD3, CD8, CD5, CD7, and CD45. Conclusion. Based on the analysis of this unusual case we performed an extensive review of the literature to elucidate the relationship between T-LGL and B-cell lymphomas and to emphasize the importance of paraprotein analysis at diagnosis of gastric MALT lymphoma.
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11
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Rashid A, Khurshid M, Ahmed A. T-cell large granular lymphocytic leukemia: 4 cases. Blood Res 2014; 49:203-5. [PMID: 25325044 PMCID: PMC4188790 DOI: 10.5045/br.2014.49.3.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anila Rashid
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Khurshid
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
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12
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Bozdag SC, Namdaroglu S, Kayikci O, Kaygusuz G, Demiriz I, Cinarsoy M, Tekgunduz E, Altuntas F. Diagnosis of large granular lymphocytic leukemia in a patient previously treated for acute myeloblastic leukemia. Hematol Rep 2014; 5:e14. [PMID: 24416499 PMCID: PMC3883061 DOI: 10.4081/hr.2013.e14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/17/2013] [Indexed: 11/24/2022] Open
Abstract
Large granular lymphocytic (LGL) leukemia is a lymphoproliferative disease characterized by the clonal expansion of cytotoxic T or natural killer cells. We report on a patient diagnosed with T-cell LGL leukemia two years after the achievement of hematologic remission for acute myeloblastic leukemia.
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Affiliation(s)
- Sinem Civriz Bozdag
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Sinem Namdaroglu
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Omur Kayikci
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Gülsah Kaygusuz
- Pathology Department, Ankara University School of Medicine , Ankara, Turkey
| | - Itir Demiriz
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Murat Cinarsoy
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Emre Tekgunduz
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
| | - Fevzi Altuntas
- Ankara Oncology Education and Research Hospital, Hematology and Stem Cell Transplantation Clinic , Ankara
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13
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14
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Wlodarski MW, Schade AE, Maciejewski JP. T-large granular lymphocyte leukemia: current molecular concepts. Hematology 2013; 11:245-56. [PMID: 17178663 DOI: 10.1080/10245330600774793] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
T-large granular lymphocyte (T-LGL) leukemia is a chronic and often indolent T cell lymphoproliferation characterized by extreme expansion of a semi-autonomous cytotoxic T lymphocyte (CTL) clone. Clinically, T-LGL can be associated with various cytopenias; neutropenia constitutes the most frequent manifestation. LGL clone represents a pathologic counterpart of the cytotoxic effector T cell but an abnormal memory CD8 cell seems to provide the supply of the matured LGL population. Analysis of clonal T cell receptor (TCR) rearrangement and complementarity determining region 3 (CDR3) of the TCR beta-chain is a useful tool to investigate clonal expansions, track the frequency of expanded clones and also clinically useful to monitor the response to therapy. The lessons learned from molecular analysis of clonal repertoire support a clinically-derived conclusion that the LGL clone arises in the context of an initially polyclonal immune response or an autoimmune process. Consequently, specific manifestations of T-LGL may be a result of the recognition spectrum of the transformed clone and the cytokines it produces. Due to the often monoclonal manifestation, T-LGL constitutes a suitable model to investigate polyclonal CTL-mediated processes. Application of new technologies, including TCR repertoire analysis by sequencing, clonotypic quantitative PCR and VB flow cytometry facilitate clinical diagnosis and may allow insights into the regulation of TCR repertoire and consequences resulting from the contraction of clonal diversity.
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MESH Headings
- Adult
- Aged
- Autoimmune Diseases/epidemiology
- CD4-Positive T-Lymphocytes/pathology
- CD8-Positive T-Lymphocytes/pathology
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Viral
- Clone Cells/pathology
- Comorbidity
- Diagnosis, Differential
- Female
- Gene Expression Regulation, Leukemic
- Gene Rearrangement, T-Lymphocyte/genetics
- Herpesviridae Infections/complications
- Humans
- Killer Cells, Natural/pathology
- Leukemia, T-Cell/diagnosis
- Leukemia, T-Cell/epidemiology
- Leukemia, T-Cell/genetics
- Leukemia, T-Cell/pathology
- Leukemia, T-Cell/physiopathology
- Leukemia, T-Cell/virology
- Leukocyte Count
- Leukocytosis/diagnosis
- Lymphocyte Activation
- Lymphoproliferative Disorders/epidemiology
- Male
- Middle Aged
- Receptors, Antigen, T-Cell/genetics
- Retroviridae Infections/complications
- T-Lymphocytes, Cytotoxic/pathology
- Tumor Virus Infections/epidemiology
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Affiliation(s)
- Marcin W Wlodarski
- Experimental Hematology and Hematopoiesis Section, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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15
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Poullot E, Bouscary D, Guyader D, Ghandour C, Roussel M, Fest T, Houot R, Lamy T. Large granular lymphocyte leukemia associated with hepatitis C virus infection and B cell lymphoma: improvement after antiviral therapy. Leuk Lymphoma 2012; 54:1797-9. [DOI: 10.3109/10428194.2012.752486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Large Granular Lymphocyte Expansion after Allogeneic Hematopoietic Stem Cell Transplant Is Associated with a Cytomegalovirus Reactivation and Shows an Indolent Outcome. Biol Blood Marrow Transplant 2012; 18:1765-70. [DOI: 10.1016/j.bbmt.2012.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/09/2012] [Indexed: 11/19/2022]
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17
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Michot JM, Tertian G, Dureault A, Taoufik Y, Noël N, Goujard C, Lazure T, Besson C, Raphael M, Lambotte O. Large granular lymphocyte leukemia and lymphomatoid granulomatosis in the same patient: fortuitous association? Leuk Lymphoma 2012; 54:432-4. [PMID: 22799270 DOI: 10.3109/10428194.2012.710906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Monoclonal B-cell lymphocytosis (MBL, CD4+/CD8 weak T-cell large granular lymphocytic leukemia (T-LGL leukemia) and monoclonal gammopathy of unknown significance (MGUS): molecular and flow cytometry characterization of three concomitant hematological disorders. Med Oncol 2012; 29:3557-60. [PMID: 22688448 DOI: 10.1007/s12032-012-0271-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/26/2012] [Indexed: 02/03/2023]
Abstract
The diagnosis of T-cell large granular lymphocytic leukemia in association with other B-cell disorders is uncommon but not unknown. However, the concomitant presence of three hematological diseases is extraordinarily rare. We report an 88-year-old male patient with three simultaneous clonal disorders, that is, CD4+/CD8(weak) T-cell large granular lymphocytic leukemia, monoclonal gammopathy of unknown significance and monoclonal B-cell lymphocytosis. The patient has only minimal complaints and has no anemia, neutropenia or thrombocytopenia. Lymphadenopathy and hepatosplenomegaly were not present. The three disorders were characterized by flow cytometry analysis, and the clonality of the T-cell large granular lymphocytic leukemia was confirmed by polymerase chain reaction. Interestingly, the patient has different B-cell clones, given that plasma cells of monoclonal gammopathy of unknown significance exhibited a kappa light-chain restriction population and, on the other hand, B-lymphocytes of monoclonal B-cell lymphocytosis exhibited a lambda light-chain restriction population. This finding does not support the antigen-driven hypothesis for the development of multi-compartment diseases, but suggests that T-cell large granular lymphocytic expansion might represent a direct antitumor immunological response to both B-cell and plasma-cell aberrant populations, as part of the immune surveillance against malignant neoplasms.
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Concomitant Epstein-Barr virus (EBV)-positive B-cell and EBV-negative T-cell posttransplant lymphoproliferative disorders after renal allografting: pathogenetic implications. Transplantation 2011; 92:e67-8. [PMID: 22158471 DOI: 10.1097/tp.0b013e31823915f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clonal drift demonstrates unexpected dynamics of the T-cell repertoire in T-large granular lymphocyte leukemia. Blood 2011; 118:4384-93. [PMID: 21865345 DOI: 10.1182/blood-2011-02-338517] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
T-cell large granular lymphocyte leukemia (T-LGLL) is characterized by chronic lymphoproliferation of cytotoxic T lymphocytes (CTLs) and is associated with lineage-restricted cytopenias. Introduction of T-cell receptor (TCR) variable β-chain (Vβ) monoclonal antibodies has facilitated identification and enumeration of clonal CTLs by flow cytometry. A highly skewed TCR Vβ repertoire identified by flow cytometry is strongly associated with monoclonal CDR3 regions by quantitative sequencing and positive TCRγ rearrangement assays. Therefore, Vβ expansions can serve as surrogate markers of CTL clonality to assess clonal kinetics in T-LGLL. We analyzed the TCR repertoire in 143 patients, 71 of which were available for serial measurements over 6 to 96 months. Although the majority (38/71, 54%) maintained a consistent monoclonal expansion, many (26/71, 37%) unexpectedly displayed a change in the dominant clone, whereby the original CTL clone contracted and another emerged as demonstrated by Vβ typing. Our results demonstrate that the T-cell repertoire is more dynamic in T-LGLL than recognized previously, illustrating the heterogeneity of disorders under this categorization.
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Zhang R, Shah MV, Loughran TP. The root of many evils: indolent large granular lymphocyte leukaemia and associated disorders. Hematol Oncol 2010; 28:105-17. [PMID: 19645074 PMCID: PMC4377226 DOI: 10.1002/hon.917] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Large granular lymphocytes (LGL) leukaemia can arise from either natural killer (NK) cells or cytotoxic T lymphocytes (CTL). The T-cell form of LGL leukaemia has significant overlap with other haematological disorders and autoimmune diseases. Here we provide an overview of LGL biology. We also focus discussion on the indolent LGL leukaemia related disorders and their causal relationships. We then discuss the potential relationships and distinctions between indolent LGL leukaemia and non-malignant clonal lymphocyte expansion that occur in otherwise healthy individuals, especially elder people.
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Affiliation(s)
- Ranran Zhang
- Penn State Hershey Cancer Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Viny AD, Lichtin A, Pohlman B, Loughran T, Maciejewski J. Chronic B-cell dyscrasias are an important clinical feature of T-LGL leukemia. Leuk Lymphoma 2009; 49:932-8. [DOI: 10.1080/10428190801932635] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Stamatopoulos K, Economidou D, Papadaki T, Vadikolia C, Papathanasiou M, Memmos D, Fassas A. Large granular lymphocyte leukemia after renal transplantation: an immunologic, immunohistochemical, and genotypic study. Transplantation 2007; 83:102-3. [PMID: 17220805 DOI: 10.1097/01.tp.0000239189.45186.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jardin F, Lévesque H, Tilly H. [Auto-immune manifestations in Non-Hodgkin's lymphoma]. Rev Med Interne 2004; 26:557-71. [PMID: 15996570 DOI: 10.1016/j.revmed.2004.11.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 11/01/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE A wide spectrum of auto-immune manifestations is frequently reported in non-Hodgkin's lymphoma (NHL). The purpose of the review is to describe the immune manifestations observed in NHL, according to their histological subtype and to discuss the current physiopathological hypothesis with their therapeutic relevance. CURRENT KNOWLEDGE AND KEY POINTS Most of the organs can be targeted by an immune process due to the lymphoproliferative disease: they include skin diseases (paraneoplastic pemphigus, vasculitis, urticaria, acrosyndromes), peripheral and central nervous system involvement (polyneuropathy, multifocal neuropathy), haematological manifestations (immune cytopenia, acquired bleeding disorders), rheumatologic diseases (arthritis, systemic vasculitis, myositis) and renal lesion (cryoglobulinemia, glomerulopathies). A higher prevalence of autoantibodies, such as antinuclear antibodies, Antiphospholipid antibodies, or endomysium antibodies, is observed in NHL but usually without clinical manifestations. In B-cell NHL, clinical and biological immune manifestations are more frequently observed in indolent lymphoma than in aggressive NHL. In T-cell NHL, immune manifestations are frequent and polymorphous, preceding usually the diagnosis of lymphoma. The prognosis value of the immune manifestations in NHL is unclear. Immune manifestations can be also be related to the treatment procedure, including fludarabine, Interferon, autograft or Rituximab. The physiopathology of the immune manifestations may involve auto-antibodies production by natural CD5+ autoreactive B-cell from which is issue the proliferation, a lost of immune tolerance, an abnormality in the Fas/Fas Ligand pathway or a chronic antigenic stimulation. FUTURE PROSPECTS AND PROJECTS As observed in T-cell lymphoma cases, immunosuppressive treatment can control both immune manifestations and lymphoproliferation, suggesting that lymphoma and auto-immunity may be the two aspects of the same process. The monoclonal antibody anti-CD20 (rituximab), able to suppress the tumoral cells and change the B-cell repertoire is the most promising treatment to cure immune disorders related to NHL. So far, rituximab has been successfully used in mixed cryoglobulinemia and cold agglutinins secondary to NHL.
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Affiliation(s)
- F Jardin
- Département d'hématologie clinique et groupe d'étude des syndromes lymphoprolifératifs, Inserm U164, centre Henri-Becquerel, 76000 Rouen, France.
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Abstract
T-cell large granular lymphocyte (LGL) leukemia is a clonal proliferation of cytotoxic T cells, which causes neutropenia, anemia, and/or thrombocytopenia. This condition is often associated with autoimmune disorders, especially rheumatoid arthritis, and other lymphoproliferative disorders. The diagnosis is suggested by flow cytometry demonstrating an expansion of CD8(+)CD57(+) T cells and is confirmed by T-cell receptor gene rearrangement studies. Mounting evidence suggests that LGL leukemia is a disorder of dysregulation of apoptosis through abnormalities in the Fas/Fas ligand pathway. In most patients, this is an indolent disorder, and significant improvement of cytopenias can be achieved with immunosuppressive agents such as steroids, methotrexate, cyclophosphamide, and cyclosporin A. This review provides a concise, up-to-date summary of LGL leukemia and the related, more aggressive, malignancies of cytotoxic T cells and natural killer cells.
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Affiliation(s)
- Michal G Rose
- Yale University School of Medicine, The Comprehensive Cancer Center (IIID), VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA.
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Abstract
The spectrum of large granular lymphocyte (LGL) proliferations consists of four distinct entities: reactive/transient LGL expansion, chronic LGL lymphocytosis, classical indolent LGL leukemia, and aggressive LGL leukemia. LGL leukemias are classified as lymphoid malignancies. They are divided into CD3(+)/T-cell LGL (85% of cases) and CD3(-)/natural killer (NK) cell LGL leukemia (15% of cases). Recent progress in the comprehension of the leukemogenesis has shown a dysregulation of survival signals in leukemic cells. Identification of LGL expansion has been improved using T-cell receptor (TCR)beta/gamma polymerase chain reaction (PCR) analysis and a combination of Vbeta and killer cell immunoglobulin-like receptor (KIR)-specific monoclonal antibodies. LGL leukemias are characterized by a clonal LGL infiltration of the bone marrow, spleen, and liver. Monoclonality is recognized by phenotypic, molecular, and karyotypic analysis. T-LGL leukemias affect the elderly and display a relatively indolent behavior. Approximately 60% to 70% of patients are symptomatic: recurrent infections secondary to chronic neutropenia, anemia, and autoimmune disease such as rheumatoid arthritis are the main clinical manifestations. Long-lasting remission can be obtained with low-dose methotrexate, cyclosporine A, or cyclophosphamide. Conversely, NK LGL leukemias behave aggressively, and most patients do not respond to chemotherapy.
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Affiliation(s)
- Thierry Lamy
- Department of Hematology, Pontchaillou University Hospital, Rennes, France
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