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T-PLL Presenting with an Indolent Course
Arsa Thammahong1,2, Narittee Sukswai3, Chantana Polprasert1,4
1Department of Medicine Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Case Reports in Hematology
|August 6, 2024
Summary
This case study details an asymptomatic patient diagnosed with T-cell prolymphocytic leukemia (T-PLL). The diagnosis was confirmed through clinical findings, cell morphology, and flow cytometry, revealing an abnormal CD4+ T-cell population.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- T-cell prolymphocytic leukemia (T-PLL) is a rare and typically aggressive mature T-cell leukemia.
- Diagnosis often relies on a combination of clinical presentation, blood morphology, and immunophenotyping.
Observation:
- An asymptomatic patient presented with incidental lymphocytosis and lymphadenopathy.
- Flow cytometry identified an expanded CD4+ T-cell population in peripheral blood.
- Next-generation sequencing confirmed T-cell receptor clonality, indicating a dominant clone.
Findings:
- No pathogenic mutations were detected in a panel of 25 lymphoma-related genes.
- The patient remained asymptomatic despite the T-PLL diagnosis.
- A conservative monitoring approach was adopted, involving regular clinical and blood count assessments.
Implications:
- This case highlights the possibility of asymptomatic T-PLL presentation.
- It underscores the utility of flow cytometry and T-cell receptor clonality in diagnosing T-PLL.
- The findings support a watchful waiting strategy for select asymptomatic T-PLL patients.
