Large granular lymphocytic leukemia

LGL with treatment indications

Cyclophosphamide +/- Prednisone

Regimen

• Cyclophosphamide (Cytoxan) 50 to 100 mg PO once per day
• Go et al. 2001, Bareau et al. 2010, and Lamy et al. 2011 mentioned steroid use with cyclophosphamide, but did not specify what exactly was used.

Lamy et al. 2011 recommends that patients who are responding are continued on treatment for 6 to 12 months; patients who do not respond within 4 months of therapy are discontinued

References

1. Go RS, Li CY, Tefferi A, Phyliky RL. Acquired pure red cell aplasia associated with lymphoproliferative disease of granular T lymphocytes. Blood. 2001 Jul 15;98(2):483-5. link to original article PubMed
2. Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica. 2010 Sep;95(9):1534-41. link to original article PubMed
3. Lamy T, Loughran TP Jr. How I treat LGL leukemia. Blood. 2011 Mar 10;117(10):2764-74. link to original article PubMed

Methotrexate +/- Prednisone

Regimen

• Methotrexate (MTX) 7.5 to 10 mg/m2 PO once per week (Lamy et al. 2011 divides the 10 mg/m2 methotrexate dose into 5 mg/m2 in the morning and 5 mg/m2 in the evening)
• Lamy et al. 2011: Patients with severe neutropenia (ANC < 200) receive Prednisone (Sterapred) 1 mg/kg PO once per day for one month, and then the dose is tapered to off during the second month

patients who are responding are continued on treatment until progression; patients who do not respond within 4 months of therapy are discontinued

References

1. Bareau B, Rey J, Hamidou M, Donadieu J, Morcet J, Reman O, Schleinitz N, Tournilhac O, Roussel M, Fest T, Lamy T. Analysis of a French cohort of patients with large granular lymphocyte leukemia: a report on 229 cases. Haematologica. 2010 Sep;95(9):1534-41. link to original article PubMed
2. Lamy T, Loughran TP Jr. How I treat LGL leukemia. Blood. 2011 Mar 10;117(10):2764-74. link to original article PubMed