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Atypical aleukemic presentation of large granular lymphocytic leukemia: a case report

Authors Bagacean C, Tempescul A, Patiu M, Fetica B, Bumbea H, Zdrenghea M

Received 27 June 2016

Accepted for publication 7 November 2016

Published 19 December 2016 Volume 2017:10 Pages 31—34

DOI https://doi.org/10.2147/OTT.S115892

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 4

Editor who approved publication: Dr Jianmin Xu

Cristina Bagacean,1,2 Adrian Tempescul,3 Mariana Patiu,1,4 Bogdan Fetica,4 Horia Bumbea,5,* Mihnea Zdrenghea1,4,*

1Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 2Laboratory of Immunology and Immunotherapy, University Hospital Brest, 3Department of Hematology, Institute of Cancerology and Hematology, Brest University Medical School, Brest, France; 4Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, 5Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

*These authors contributed equally to this work

Abstract: Large granular lymphocytic leukemia (LGLL) is a rare lymphoproliferative disorder of transformed natural killer or T-cells attributed to chronic exposure to the proinflammatory cytokine IL-15. Diagnosis of the majority of T-cell LGLL is established by documenting clonal large granular lymphocytes (LGLs) in peripheral blood, by morphology and immunophenotype. The proteasome inhibitor bortezomib is known to target molecular pathways downstream of the IL-15 receptor signaling and has been proposed as a therapy in these patients. We report an uncommon presentation of LGLL with chronic neutropenia lacking typical blood LGLs, which failed to respond to bortezomib but obtained a very good partial remission with a classical methotrexate regimen.

Keywords: large granular lymphocytes, lymphoproliferative, Felty, neutropenia, bortezomib

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