Treatment of Large Granular Lymphocyte Leukemia With Oral Low-Dose Methotrexate

Morbidity and mortality in patients with T large granular lymphocyte (T-LGL) leukemia resutt from infections acquired during severe neutropenia. Optimum treatment for severe neutropenia remains undefined. We conducted an uncontrolled but prospective study of low-dose oral methotrexate, up to 10 mg/ma weekly, in 10 patients with this disease. Therapeutic response was assessed by serial clinical evaluations and laboratory determinations including complete blood counts, lymphocyte phenotyping, and T-cell receptor gene rearrangement studies. A partial response was defined as a sustained increase in neutrophil count greater than 500/ pL. A complete clinical remission was defined as achievement of a normal complete blood count and CD3' LGL count. Previous prednisone treatment in eight of these patient had produced one clinical remission and four partial responses;