Lessons from a case of T-cell large granular lymphocytic leukaemia suggesting that immunomodulatory therapy is more effective than intensive treatment.
Leukemia treatment strives to eradicate the malignant clone. With T-cell large granular lymphocytic (LGL) leukemia, the onus of treatment appears to be modification of the disease rather than eradication of the clone. We describe a case of T-cell LGL leukemia where aggressive, eradicative type therapy proved ineffective. The patient achieved hematological response to low dose oral methotrexate after failing to respond to and/or tolerate eight previous treatments including CAMPATH-1H and peripheral blood stem cell transplantation. We highlight the resistant nature of the LGL clone and discuss the relative merits of immunomodulatory type therapy in this disease.
Osuji
Nnenna
N
Section of Haemato-Oncology, Department of Histopathology, Institute of Cancer Research, Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom.
Matutes
Estella
E
Wotherspoon
Andrew
A
Catovsky
Daniel
D
D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007167:Immunotherapy / Q000379:methods; D015458:Leukemia, T-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000494:pharmacology*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods; D013601:T-Lymphocytes / Q000187:drug effects* / Q000473:pathology
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D008727:Methotrexate