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Post-Transplant Events

Large granular lymphocytosis and its impact on long-term clinical outcomes following allo-SCT

Bone Marrow Transplantation volume 48, pages 1104–1111 (2013)Cite this article

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Abstract

A total of 418 patients receiving hematopoietic SCT and surviving beyond day 100 were examined for the occurrence of large granular lymphocytes (LGLs). LGL lymphocytosis was defined as the presence of at least two of the following criteria: (1) sustained lymphocytosis above 3.0 × 109/L observed in at least three consecutive determinations over a time frame of 2–3 months, (2) predominance (>30%) of LGLs in peripheral blood, (3) confirmation of monoclonality by T-cell receptor analysis using PCR 77 patients developed LGL lymphocytosis during their post-transplant course with a median onset of 312 days from transplant. The cumulative incidence at 1-, 2- and 3-years was 12.3±1.8, 20.8±2.4 and 23.6±2.7%. Patients with LGL lymphocytosis showed an OS advantage (86.2 vs 53.8%, P<0.001), lower non-relapse mortality (NRM; 3.2 vs 27.3%, P<0.001) and lower relapse incidence (9.6 vs 29.4%, P<0.001). Three clinical factors were associated with the development of LGL lymphocytosis: (1) CMV seropositive recipients (CMV-R+) compared with CMV seronegative recipients (CMV-R−; P<0.001) regardless of CMV serostatus of donor; (2) CMV reactivation (P<0.001); (3) chronic GVHD (P=0.007). In conclusion, the incidence of LGL lymphocytosis following allogeneic hematopoietic SCT was detected in ∼20% of recipients and is associated with favorable outcomes.

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Author notes

  1. D (Dong Hwan) Kim and G Al-Dawsari: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada

    D (Dong Hwan) Kim, G Al-Dawsari, V Gupta, J Kuruvilla, J H Lipton & H A Messner

  2. Department of Biostatistics, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada

    T Panzarella

  3. Department of Pathology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada

    H Chang

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  1. D (Dong Hwan) Kim
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Correspondence to D (Dong Hwan) Kim.

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Author Contributions

DK and GA contributed equally to the design of the study, the supervision of data collection and of data interpretation, data analysis and writing of the manuscript. TP was responsible for the statistical analysis. HC was involved in the design of study, collection and interpretation of the data. VG, JK and JL were involved in the supervision of the data collection, interpretation of the data and critical revision of the manuscript. HM contributed to the design of study, the supervision of data collection and of data interpretation, data analysis and critical revision of the manuscript.

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(Dong Hwan) Kim, D., Al-Dawsari, G., Chang, H. et al. Large granular lymphocytosis and its impact on long-term clinical outcomes following allo-SCT. Bone Marrow Transplant 48, 1104–1111 (2013). https://doi.org/10.1038/bmt.2013.5

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