T-cell large granular lymphocyte leukemia of donor origin after allogeneic bone marrow transplantation

TitleT-cell large granular lymphocyte leukemia of donor origin after allogeneic bone marrow transplantation
Publication TypeJournal Article
Year of Publication2003
AuthorsAu WY, Lam CC, Lie AK, Pang A, Kwong YL
JournalAm J Clin Pathol
Volume120
Issue4
Pagination626 - 30
Date PublishedOct
Accession Number14560574
Keywords*Tissue Donors, Adult, Base Sequence, Bone Marrow Transplantation / *adverse effects, Clone Cells, DNA Mutational Analysis, DNA, Neoplasm / analysis, Fatal Outcome, Humans, Leukemia, Myeloid, Chronic / immunology / *therapy, Leukemia, T-Cell, Chronic / etiology / genetics / *pathology, Male, Microsatellite Repeats, Molecular Sequence Data, Receptors, Antigen, T-Cell, gamma-delta / genetics, Research Support, Non-U.S. Gov't, Reverse Transcriptase Polymerase Chain Reaction, T-Lymphocyte Subsets, Transplantation Chimera, Transplantation, Homologous
Abstract

A 39-year-old man with chronic myeloid leukemia in accelerated phase underwent allogeneic bone marrow transplantation (BMT). At 6 months after BMT, lymphocytosis (WBC count, 23,100/microL [23.1 x 10(9)/L]; 80% (0.80) large granular lymphocytes [LGLs]) occurred. The LGLs were CD3+CD4-CD8+, with clonally rearranged T-cell receptor gamma gene, and of donor origin, as shown by analysis of polymorphic microsatellite markers. Epstein-Barr virus was not present. The diagnosis, therefore, was consistent with T-cell large granular lymphocytic (T-LGL) leukemia. Corticosteroids controlled the LGL count, but progressive pancytopenia led to death 4 months later. Retrospective analysis showed that the T-LGL leukemia apparently had arisen as early as 3 months after BMT. The distinguishing features of this case included donor origin, neoplastic nature, and the aggressive fatal outcome.

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