Gammadelta T-cell large granular lymphocyte (LGL) leukemia with spontaneous remission.
T-cell large granular lymphocyte (LGL) leukemia is a clonal disorder with an indolent clinical course. In July 1995, a 46-year-old Japanese man was admitted to our hospital because his anemia had progressed. He had a white blood cell count of 3.9 x 10(9)/L with 75% lymphocytes, which were intermediate to large and had almost round nuclei and azurophilic granules, and anemia with a red blood cell count (RBC) of 2.69 x 10(12)/L, hemoglobin (Hb) of 9.5 g/dL, and hematocrit (Hct) of 28.3%. Electron microscopic examination showed that most of the lymphocytes had a parallel tubular array and dense core granules in their cytoplasm. Flow cytometry and Southern blotting of the T-cell antigen receptor (TCR) genes using the peripheral blood species showed monoclonal proliferation of LGLs with a CD3+, TCRgammadelta+, CD4-, CD8-, CD16+, CD56-, CD57-, HLA-DR+ phenotype, and a TCR gamma gene rearrangement, respectively, suggesting that the patient was diagnosed as having gammadelta T-cell LGL leukemia. He had no symptoms, organomegaly, or skin lesions. About 1.5 years after diagnosis, the anemia gradually improved with disappearance and appearance of a rearranged band in the TCR-gamma gene and TCR-beta gene, respectively. About 7 years after diagnosis, the anemia improved completely with a RBC of 5.01 x 10(12)/L, Hb of 14.8 g/dL, and Hct of 44.3%, and he was in complete remission without TCR-beta and -gamma gene rearrangements. He had received no therapy. This is the first report of spontaneous remission of gammadelta T-cell LGL leukemia.
First Department of Internal Medicine, Fukushima Medical University, Fukushima, Japan. t-shichi@fmu.ac.jp
Tsutomu
T
Shichishima
Michiko
M
Kawaguchi
Nobutaka
N
Ono
Kazuo
K
Oshimi
Naoya
N
Nakamura
Yukio
Y
Maruyama
D015139:Blotting, Southern; D015329:Gene Rearrangement, T-Lymphocyte; D006801:Humans; D015458:Leukemia, T-Cell / Q000235:genetics / Q000473:pathology*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000235:genetics*; D012075:Remission, Spontaneous; D016176:T-Lymphocyte Subsets
D016692:Receptors, Antigen, T-Cell, gamma-delta