The Pathologist's Approach to T-Cell Large Granular Lymphocytic Leukemia Diagnosis: A Multicenter Comparative Study by the Bone Marrow Pathology Group
Jadee L Neff, Xiangshan Fan, Robert Ohgami, Yue Wu, Sarah M Choi, Rebecca L King, Damian J Tagliente, Adam Bagg, Attilio Orazi, Daniel A Arber, Sa A Wang, William G Morice II. Mayo Clinic, Rochester, MN; Stanford School of Medicine, Stanford, CA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Weill Cornell Medical College, New York, NY; MD Anderson Cancer Center, Houston, TX
Background: Clinically, T-cell large granular lymphocytic leukemia (T-LGL) is diagnosed by documentation of an increase in peripheral blood (PB) large granular lymphocytes in the setting of unexplained cytopenia. A number of pathologic studies can be used to establish T-LGL, including flow cytometric (FC) T-cell phenotyping, bone marrow (BM) biopsy and immunohistochemistry (IHC), and T-cell clonality assessment. The expected findings from these studies in T-LGL are described in the WHO Classification scheme; however, the frequency with which they are employed in routine case evaluation is unknown. To address this, data from 5 major academic medical centers was compared.
Design: Clinical and laboratory data from 201 T-LGL cases identified in the files of 5 major academic medical centers were compared.
Results: The CBC and clinical data in Table 1 match those expected of T-LGL; treatment was required in 49%. An associated non-T-LGL hematologic disorder was present in 28%, an autoimmune disorder in 22%.
|Median Age, (y)||60|
|% Hemoglobin<10.0 g/dL||26%|
|%ANC<1.5 x 10(9)/L||60%|
|%Platelet<100 x 10(9)/L||13%|
|%Abs GL Count>2.5 x 10(9)/L||58%|
|% Flow Cytometry||99%|
|% BM Biopsy||85%|
|% BM IHC||60%|
|% T-cell gene rearrangement||90%|