T-cell Large Granular Lymphocytic Leukemia Manifesting in Patients with HIV-1 Infection: Cases Series and Review of the Literature
Main Article Content
Keywords
T-cell LGLL, HIV-1, AIDS, clonal, large granular lymphocyte, leukemia
Abstract
We report five patients with human immunodeficiency virus-1/acquired immunodeficiency syndrome (HIV-1/AIDS) who developed T-cell large granular lymphocytic leukemia (T-LGLL). None of the patients fulfilled criteria for diagnosis of diffuse infiltrative lymphocyte syndrome (DILS) or HIV-associated CD8+ lymphocytosis syndrome at the time of diagnosis of LGLL. The immunophenotype of malignant T-cells was identical in three patients with co-expression of CD3, CD8, CD57, and T-cell receptor (TCR) alpha/beta. Three out of five patients were also diagnosed with clonal disorders of B-cell origin including diffuse large B-cell lymphoma, Burkitt’s lymphoma, and monoclonal gammopathy of undetermined significance (MGUS). Two patients developed cytopenias due to T-LGLL prompting initiation of therapy. Our study suggests that chronic viral infection with HIV can contribute to evolution of T-LGLL. Clinical and laboratory characteristics of T-LGLL associated with HIV-1/AIDS resemble those of immunocompetent patients.
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References
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Itescu S, Rose S, Dwyer E and Winchester R: Certain HLA-DR5 and –DR6 major histocompatibility complex class II alleles are associated with a CD8 lymphocytic host response to human immunodeficiency virus type 1 characterized by low lymphocyte viral strain heterogeneity and slow disease progression. Proc Natl Acad Sci USA 1994; 91;11472-76.
Ghrenassia, Etienne, Louise Roulin, Aude Aline-Fardin, Christophe Marzac, Frederic Feger, Julie Gay, Jerome Pacanowski, Alexandre Hertig, and Paul Coppo. "The Spectrum of Chronic CD8 T-Cell Expansions: Clinical Features in 14 Patients." PLoS ONE 9.3 (2014): n. pag. Web.
Viny AD, Lichtin A, Pohlman et al. Chronic B-cell dyscrasias are an important clinical feature of T-LGL leukemia. Leuk Lymphoma 2008;49:932-938.
Isenalumhe L., Van den Bergh M., Wang E., et al. Frequency of additional malignancies in patients with large granular lymphocytic leukemia (LGLL): A single Institutional experience. J Clin Oncol. 2017; 35(8 Supplement): 7542.
Van den Bergh M., Isenalumhe L., Wang E., et al. A single institution analysis of patients with dual diagnosis of T-cell large granular lymphocytic leukemia and either a plasma cell and/or a B-cell lymphoproliferative Disorder. Clin Lymphoma Myeloma Leuk. 2016; 16 (2 Supplement): 117.
Van den Bergh M., Isenalumhe L., Wang E., et al. A single institutional experience of 261 patients with large granular lymphocytic leukemia. J Clin Oncol. 2017; 35(15 Supplement): 7555.
Pulik M, Lionnet F, Genet P, Petitddier C, Jary L, Fourcade C: CD3+CD8+CD56- clonal large granular lymphocyte leukaemia and HIV infection. Br J Haematol 1997;98:444-445.
Ghali V, Casgtella A, Louis-Charles A, Agranovsky E, Croxson ST: Expansion of large granular lymphocytes (natural killer cells) with limited antigen expression (CD2+, CD3-, CD4-, CD8-, CD16+, NKH-1) in a human immunodeficiency virus-positive homosexual man. Cancer 1990;65:2243-2247.
Moir S, Chun TW, Fauci AS. Pathogenic mechanisms of HIV disease. Annu Reve Pathol 2011;6:223-248.
Diamond C, Taylor TH, Aboumrad T, et al. Changes in acquired immunodeficiency syndrome-related non-Hodgkin lymphoma in the era of highly active antiretroviral therapy: incidence, presentation, treatment, and survival. Cancer 2006;106:128–35.
Lim ST, Karim R, Tulpule A et al. Prognostic factors in HIV-related diffuse large-cell lymphoma: before versus after highly active antiretroviral therapy. J Clin Oncol 2005;23:8477-8482. Epub 2005 Oct 17.
Arzoo KK, Bu X, Espina BM, Seneviratne L, Nathwani B, Levine AM. T-cell lymphoma in HIV-infected patients. J Acquir Immune Defic Syndr 2004;15:1020-1027.
Collins JA, Hernández AV, Hidalgo JA, Villena J, Sumire J, Delgado V, Salazar R. High proportion of T-cell systemic non-Hodgkin lymphoma in HIV-infected patients in Lima, Peru. A Acquir Immune Defic Syndr 2005;40:558-564.
Brugnoni D, Prati E, Cattaneo R, et al. The primary response to HIV infection is characterized by an expansion of activated CD8+CD28- cells. AIDS 1996;10-104-106.
Smith PR, Cavenagh JD, Milne T, Howe D, Wilkes SJ, Sinnott P, Forster GE, Helbert M: Benign monoclonal expansion of CD8+ lymphocytes in HIV infection. J Clin Pathol 2000;53:177-181.
Itescu S, Brancato LJ, Winchestger R: A sicca syndrome in HIV infection: association with HLA-DR5 and CD8 lymphocytosis. Lancet 1989;8661:466-468.
Basu D, Williams FM, Ahn CW, Reveille JD. Changing Spectrum of the Diffuse Infiltrative Lymphocytosis Syndrome. Arhtritis&Rheumatism (Arthritis Care&Research)2006;55:466-472.
Itescu S, Rose S, Dwyer E and Winchester R: Certain HLA-DR5 and –DR6 major histocompatibility complex class II alleles are associated with a CD8 lymphocytic host response to human immunodeficiency virus type 1 characterized by low lymphocyte viral strain heterogeneity and slow disease progression. Proc Natl Acad Sci USA 1994; 91;11472-76.
Ghrenassia, Etienne, Louise Roulin, Aude Aline-Fardin, Christophe Marzac, Frederic Feger, Julie Gay, Jerome Pacanowski, Alexandre Hertig, and Paul Coppo. "The Spectrum of Chronic CD8 T-Cell Expansions: Clinical Features in 14 Patients." PLoS ONE 9.3 (2014): n. pag. Web.
Viny AD, Lichtin A, Pohlman et al. Chronic B-cell dyscrasias are an important clinical feature of T-LGL leukemia. Leuk Lymphoma 2008;49:932-938.
Isenalumhe L., Van den Bergh M., Wang E., et al. Frequency of additional malignancies in patients with large granular lymphocytic leukemia (LGLL): A single Institutional experience. J Clin Oncol. 2017; 35(8 Supplement): 7542.
Van den Bergh M., Isenalumhe L., Wang E., et al. A single institution analysis of patients with dual diagnosis of T-cell large granular lymphocytic leukemia and either a plasma cell and/or a B-cell lymphoproliferative Disorder. Clin Lymphoma Myeloma Leuk. 2016; 16 (2 Supplement): 117.