Large granular lymphocyte expansion after allogeneic hematopoietic stem cell transplant is associated with a cytomegalovirus reactivation and shows an indolent outcome.
Expansions of CD3+ large granular lymphocytes (LGLs) after allogeneic hematopoietic stem cell transplantation (HSCT) have been described. We sought to evaluate incidence, characteristics, and clinical significance of persistent T cell (T-)LGL after HSCT. Fourteen of 215 recipients (7%) were diagnosed with LGL expansions. Thirteen showed a CD3+/CD8+ immunophenotype, 5 of them with clonal TCR-γ rearrangement. The lymphocytes appeared at a median of 16 months (range, 3-58 months) after HSCT and lasted for a median time of 31 months (range, 2-179 months). Cytomegalovirus (CMV) reactivation (P = .001) and acute graft-versus-host disease (aGVHD) were associated with LGL expansion (P = .02). In the multivariate analysis, only CMV reactivation showed a significant association with T-LGL expansion (relative risk [RR]: 5.063; 95% confidence interval [CI]: 1.586-16.160; P = .006). The observed posttransplantation LGL expansions, even if monoclonal, showed a chronic, indolent course. Our data indicate that such expansions may be considered as an expression of chronic stimulation, triggered by CMV reactivation rather than a malignant transformation.
Department of Hematology, University Hospital of Basel, Basel, Switzerland.
Sabine
S
Nann-Rütti
Alexander
A
Tzankov
Nathan
N
Cantoni
Jörg
J
Halter
Dominik
D
Heim
Dimitrios
D
Tsakiris
Caroline
C
Arber
Andreas
A
Buser
Alois
A
Gratwohl
André
A
Tichelli
Alicia
A
Rovó
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D017252:CD3 Complex / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D002648:Child; D003430:Cross-Sectional Studies; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000276:immunology / Q000473:pathology* / Q000821:virology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014184:Transplantation, Homologous; D014775:Virus Activation
D017252:CD3 Complex