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True T-cell chronic lymphocytic leukemia: a morphologic and
immunophenotypic study of 25 cases [see comments]
JD Hoyer, CW Ross, CY Li, TE Witzig, RD Gascoyne, GW Dewald and CA Hanson
Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.
We studied 25 T-cell chronic lymphocytic leukemia (T-CLL) cases collected
over a 15-year period. Immunophenotypic analysis was performed in each
case; 12 cases were evaluated by cytogenetics, and gene rearrangement
studies were performed in 14 cases. The median age was 57 years with a male
predominance (M:F, 15:10). The median presenting lymphocyte count was 36.3
x 10(9)/L (range, 3.9 to 438 x 10(9)/L). Fourteen patients (56%) had shotty
adenopathy and ten (40%) had mild-to-moderate splenomegaly at presentation;
four (16%) had erythematous skin lesions. The lymphocytes were
predominantly small; some cases had a minor component of medium-sized cells
(< 10%). The nuclear: cytoplasmic ratios were uniformly high with round
to oval nuclei; however, a wide spectrum of nuclear outlines could be
found, ranging from minimally to markedly convoluted. Nucleoli were either
absent or small and inconspicuous. These lymphocytes did not have the
morphology of prolymphocytes and did not contain cytoplasmic granules. Bone
marrow infiltration was generally in an interstitial pattern; the degree of
involvement ranged from 15% to 90%. Immunophenotyping showed that the
lymphocytes were mature T-cells with a predominant CD4+ immunophenotype.
Three cases displayed a CD8+ immunophenotype. The patients were treated
with a variety of chemotherapeutic regimens with only a minimal response
observed in two of 20 patients. We conclude that T-CLL is an uncommon
chronic lymphoproliferative disorder (CLPD) that can be morphologically
similar to B-CLL, is distinct from T- prolymphocytic leukemia, and has an
aggressive clinical course that is refractory to therapy. It may also be
difficult to distinguish T-CLL from other T-CLPD, especially the leukemic
phase of peripheral T-cell lymphoma and some cases of Sezary syndrome.
Volume 86,
Issue 3,
pp. 1163-1169,
08/01/1995
Copyright © 1995 by The American Society of Hematology
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