Single-center Series of Bone Marrow Biopsy-Defined Large Granular Lymphocyte Leukemia: High Rates of Sustained Response to Oral Methotrexate.

Abstract

INTRODUCTION:

Large granular lymphocyte (LGL) leukemia is a rare chronic lymphoproliferative disorder, with few large series reported to date. Series using stringent diagnostic criteria incorporating bone marrow biopsy (BMB), immunophenotyping, and T-cell receptor rearrangements are even scarcer.

PATIENTS AND METHODS:

The present study was a single-center series of 39 patients with LGL leukemia diagnosed using immunohistochemical analysis of BMB samples and flow cytometric and molecular data.

RESULTS:

With a median follow-up of 3.2 years (range, 1.0-15.1 years), 15 patients (38%) never required treatment. Of the remaining 24 patients requiring treatment, 13 were initially treated with prednisolone, for an overall response rate (ORR) of 84.6% and a median duration of response (DOR) of 13.5 months (range, 5.7-70.3 months). Of the 24 patients, 9 received oral low-dose weekly methotrexate as first-line therapy, with 8 (89%) achieving a hematologic response and a median DOR of 132.7 months (range, 6.7-180.5 months). Another 5 patients received methotrexate after prednisolone failure; all 5 responded, with a median DOR of 14 months (range, 4-96 months). Only 2 patients developed progression during methotrexate therapy, and 4 patients experienced responses lasting ≥ 5 years.

CONCLUSION:

Single-agent oral methotrexate appears to be highly efficacious, resulting in long response durations and minimal toxicity.

• Authors: Talha Munir, Mark J Bishton, Ian Carter, Andrew McMillan, Simon O'Connor, Vishakha Sovani, Andrew P Haynes, Christopher P Fox
• Journal: Clinical lymphoma, myeloma & leukemia (Clin Lymphoma Myeloma Leuk) Vol. 16 Issue 12 Pg. 705-712 (12 2016) ISSN: 2152-2669 [Electronic] United States
• PMID: 27640075 (Publication Type: Journal Article)
• Copyright: Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antimetabolites, Antineoplastic
• Methotrexate

Topics

• Administration, Oral
• Adult
• Aged
• Aged, 80 and over
• Antimetabolites, Antineoplastic (administration & dosage)
• Biopsy
• Bone Marrow (pathology)
• Female
• Follow-Up Studies
• Gene Rearrangement, T-Lymphocyte
• Humans
• Immunophenotyping
• Leukemia, Large Granular Lymphocytic (diagnosis, drug therapy, metabolism, mortality)
• Male
• Methotrexate (administration & dosage)
• Middle Aged
• Survival Analysis
• Treatment Outcome
• Young Adult