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International Journal of Hematology

, Volume 110, Issue 3, pp 313–321 | Cite as

T-cell large granular lymphocyte leukemia in solid organ transplant recipients: case series and review of the literature

  • Gaetano AlfanoEmail author
  • Francesco Fontana
  • Elisabetta Colaci
  • Giacomo Mori
  • Caterina Cerami
  • Andrea Messerotti
  • Leonardo Potenza
  • Mario Luppi
  • Gianni Cappelli
Original Article

Abstract

T-cell large granular lymphocyte (T-LGL) leukemia is a rare clonal proliferation of cytotoxic lymphocytes rarely described in solid organ transplant (SOT). We reviewed records from 656 kidney transplant recipients in follow-up at our Center from January 1998 to July 2017. In addition, we researched, through PubMed, further reports of T-LGL leukemia in SOT from March 1981 to December 2017. We identified six cases of T-LGL leukemia in our cohort of patients and 10 in the literature. This lymphoproliferative disorder was detected in one combined liver–kidney, one liver and 14–kidney transplant recipients. Median age at presentation was 46.5 years (IQR 39.2–56.9). The disease developed after a median age of 10 years (IQR 4.9–12) from transplantation. Anemia was the most common presentation (62.5%) followed by lymphocytosis (43.7%) and thrombocytopenia (31.2%). Splenomegaly was reported in 43.7% of the patients. Eight patients (50%) who experienced severe symptoms were treated with non-specific immunosuppressive agents. Six of them (75%) had a good outcome, whereas two (25%) remained red blood cell transfusion dependent. No cases progressed to aggressive T-LGL leukemia or died of cancer at the end of follow-up. These results suggest that T-LGL leukemia is a rare but potentially disruptive hematological disorder in the post-transplant period.

Keywords

T-cell large granular lymphocyte leukemia T-LGL Post-transplant lymphoproliferative disorder Anemia Solid organ transplantation 

Abbreviations

AIHA

Autoimmune hemolytic anemia

Anti-dsDNA

Anti-double-stranded DNA

B19V

Parvovirus B19

CMV

Cytomegalovirus

EBV

Epstein Barr virus

GFR

Glomerular filtration rate

HTLV

T cell lymphotropic virus

IQR

Interquartile range

KT

Kidney transplant

LGL

Large granular lymphocyte

LGLs

Large granular lymphocytes

MBL

Monoclonal B cell lymphocytosis

MGUS

Monoclonal gammopathy of undetermined significance

m-TORi

Inhibitor of mammalian target of rapamycin

PRCA

Pure red cell aplasia

PTLD

Post-transplant lymphoproliferative disorder

SOT

Solid organ transplant

TCR

T-cell receptor

T-LGL

T-cell large granular lymphocyte

Notes

Author contributions

All the Authors listed above met the following criteria recommended by International Committee of Medical Journal Editors. In particular: AG designed study. AG, FF and CE performed the study and wrote the paper. MA, MG, CC collected data. PL, LM and CG analyzed data and reviewed the paper. All Authors approved the final version of the manuscript to be published and were accountable for any part of the work.

Funding

The authors declare no funding sources.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Surgical, Medical and Dental Department of Morphological Sciences, Section of NephrologyUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Nephrology Dialysis and Transplant UnitUniversity Hospital of ModenaModenaItaly
  3. 3.Section of Hematology, Surgical, Medical and Dental Department of Morphological SciencesUniversity of Modena and Reggio Emilia, University Hospital of ModenaModenaItaly

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