Response to granulocyte-macrophage colony-stimulating factor (GM-CSF) but not to G-CSF in a case of agranulocytosis associated with large granular lymphocyte (LGL) leukemia.

Large granular lymphocyte (LGL) leukemia is an uncommon lymphoproliferative disorder characterized by an expansion of CD3' and less frequently CD3lymphocytes.' In more than 80% of cases, severe neutropenia (neutrophils <0.5 X 109/L) is observed? The mechanism responsible for inhibition of granulopoiesis remains controversial. LGL proliferation may suppress granulopoiesis either directly or indirectly by means of immune factors such as circulating antibodies. Granulocyte colony-stimulating factor (G-CSF) has been tested in chronic idiopathic neutropenia and in Felty's syndrome.'d Responses to G-CSF or granulocyte-macrophage colony-stimulating factor (GM-CSF) in agranulocytosis associated with LGL leukemia have been reported in a few cases?4 It has been recently suggested that T p clonal diseases respond better to G-CSF than GM-CSF.' We report a patient suffering from agranulocytosis associated with monoclonal LGL leukemia who failed to respond to G-CSF and had a transient remission after GM-CSF.