T-cell large granular lymphocyte leukemia of donor origin after allogeneic bone marrow transplantation.
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.
Au
Wing Y
WY
University Department of Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China.
Lam
Clarence C
CC
Lie
Albert K
AK
Pang
Annie
A
Kwong
Yok L
YL
D000328:Adult; D001483:Base Sequence; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002999:Clone Cells; D004252:DNA Mutational Analysis; D004273:DNA, Neoplasm / Q000032:analysis; D017809:Fatal Outcome; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000628:therapy*; D015461:Leukemia, Prolymphocytic, T-Cell / Q000209:etiology / Q000235:genetics / Q000473:pathology*; D008297:Male; D018895:Microsatellite Repeats; D008969:Molecular Sequence Data; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016176:T-Lymphocyte Subsets; D014019:Tissue Donors; D018183:Transplantation Chimera; D014184:Transplantation, Homologous
D004273:DNA, Neoplasm; D016692:Receptors, Antigen, T-Cell, gamma-delta