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T-Cell Large Granular Lymphocyte Leukemia of Donor Origin After Allogeneic Bone Marrow Transplantation

Wing Y. Au MRCP, Clarence C.K. Lam MRCPath, Albert K.W. Lie FRCPA, Annie Pang, Yok L. Kwong FRCPath
DOI: http://dx.doi.org/10.1309/VA755A03PVRV9XDT 626-630 First published online: 1 October 2003


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/μL [23.1 × 109/L]; 80% (0.80) large granular lymphocytes [LGLs]) occurred. The LGLs were CD3+CD4–CD8+, with clonally rearranged T-cell receptor γ 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.

Key Words:
  • T-cell large granular lymphocyte leukemia
  • Allogeneic BMT
  • Bone marrow transplantation