INDUCTION OF CLINICAL REMISSION IN T-LARGE GRANULAR LYMPHOCYTE LEUKEMIA WITH CYCLOSPORINE-A, MONITORED BY USE OF IMMUNOPHENOTYPING WITH V-BETA ANTIBODIES

A 54-year-old woman presented with a severe autoimmune anemia, thromba cytapenia, neutropenia (Evans' syndrome), and CD8(+) lymphocytosis, wi thout signs of lymphradenopathy or splenomegaly. A diagnosis of T cell large granular lymphocyte (T-LGL) leukemia was made, based on cytomor phology, the typical +)/CD4(-)/CD8(+)/CD16(+)/CD56(-)/CD57(-)/HLA-DR+/ - immunophenotype of the lymphocytosis (9 x 10(9)/I), and biallelic cl onally rearranged T cell receptor beta (TCR beta) genes. Clonality of the TGR alpha beta(+) T-LGL was also demonstrated with a panel of anti bodies against variable domains of TCR beta chains, which showed singl e V beta 7.1 expression on the CD3(+) T-lymphocytes. After treatment f ailure with corticosteroids, splenectomy, and cyclophosphamide, respec tively, a complete clinical remission was induced and sustained with c yclosporin A. V beta 7.CD8/CD3 triple immunofluorescence stainings app eared to he valuable for titrating the cyclosporin A dosage by monitor ing the T-LGL cells during treatment.