T-cell large granular lymphocytic leukemia: 4 cases

Do cy-togenetic abnormalities precede morphologic abnormalities in a developing malignant condition? Eur J Haematol 2007;78: 152-6. 4. Wong KF, Kwong YL. Isochromosome 8q is a marker of secondary acute myeloid leukemia. Deletion of 6q16-q21 in human lymphoid malignancies: a mapping and deletion analysis. et al. 6q deletion detected by fluorescence in situ hybridization using bacterial artificial chromosome in chronic lymphocytic leukemia. Aplastic anaemia preceding acute lympho-blastic leukaemia in an adult with isolated deletion of chromosome 9q. T-cell large granular lymphocytic leukemia: 4 cases TO THE EDITOR: T-cell large granular lymphocytic leuke-mia (T-LGL) is a rare clonal hematological disorder characterized by peripheral blood and bone marrow lymphocytic infiltration with large granular lymphocytes (LGLs), spleno-megaly, and cytopenia, of which neutropenia is most common [1]. T-LGL is characterized by persistent increases in LGLs ranging from 2×10 9 /L to 20×10 9 /L on peripheral blood in the absence of a reactive cause [2]. The exact pathogenesis is unknown, but is believed to result from clonal expansion of mature postthymic T cells [3]. T-LGL typically presents in the sixth decade of life, with an equal male to female ratio [4]. Approximately 40% of patients have an associated autoimmune disorder, most commonly rheumatoid arthritis (RA), pure red cell aplasia, or immune thrombocytopenia [5]. Approximately one third of patients are asymptomatic when routine blood counts reveal cytopenia and LGL, which leads to diagnosis. The symptoms, if present, are related to cytopenia [6]. Bone marrow aspirate may be required to confirm the diagnosis, especially in those with low absolute numbers of circulating LGLs. Patients with T-LGL have a median survival of more than 10 years [7]. The most common indications for treatment are cytopenia, recurrent infection, pure red cell aplasia, progressive splenomegaly, and B symptoms [8]. The reported incidence of T-LGL is 2–5% of the chronic lymphoproliferative disorders (LPDs) in North America and about 6% in Asia [9]. The incidence and prevalence is not known in Pakistan. In this case series, we describe the laboratory findings and clinical courses of 4 patients diagnosed with T-LGL in a tertiary care hospital. CASES The first case was a 24-year-old man who presented with lymphocytosis in November 2010. His physical examination was unremarkable and showed no hepatosplenomegaly or lymphadenopathy. A complete blood cell (CBC) count revealed lymphocytosis with the presence of LGLs (Table 1). Based on bone marrow morphological and im-munophenotypic assessments, the patient was diagnosed with T-LGL (Table 1). …