Difference between revisions of "HAEM5:T-prolymphocytic leukaemia"

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Primary Author(s)*

Parastou Tizro, MD, Celeste C. Eno, PHD, Sumire Kitahara, MD

WHO Classification of Disease

(Will be autogenerated; Book will include name of specific book and have a link to the online WHO site)

Structure	Disease
Book
Category
Family
Type
Subtype(s)

Definition / Description of Disease

T-prolymphocytic leukemia (T-PLL) is an aggressive form of T-cell leukemia marked by the proliferation of small to medium-sized prolymphocytes exhibiting a mature post-thymic T-cell phenotype.^[1]

Synonyms / Terminology

T-cell chronic lymphocytic leukemia

Epidemiology / Prevalence

T-PLL is an uncommon disease, accounting for approximately 2% of all mature lymphoid leukemias in adults. It mainly affects older individuals, with a median onset age of 65 years, ranging from 30 to 94 years. The disorder exhibits a slight male predominance, with a male to female ratio of 1.33:1.^[1]

Clinical Features

The most prevalent symptom of the disease is a leukemic presentation, characterized by a rapid, exponential increase in lymphocyte counts, which exceed 100 × 10^9/L in 75% of patients. Approximately 30% of patients may initially experience an asymptomatic, slow-progressing phase, but this typically develops into an active disease state.^[1]^[2]

Signs and Symptoms	B symptoms (Fever, night sweats, weight loss) Hepatosplenomegaly (Frequently observed) Generalized lymphadenopathy with slightly enlarged lymph nodes (Frequently observed) Cutaneous involvement (20%) Malignant effusions (15%)
Laboratory Findings	Anemia and thrombocytopenia Marked lymphocytosis > 100 × 10^9/L (75% of cases) Atypical lymphocytosis > 5 × 10^9/L Serum lactate dehydrogenase (LDH) (increased-may reflect disease burden) β2 microglobulin (B2M) (increased-may reflect disease burden)

Sites of Involvement

Peripheral blood, bone marrow, spleen (mostly red pulp), liver, lymph node (mostly paracortical), and sometimes skin and serosa (primarily pleura). Extra lymphatic and extramedullary atypical manifestations including skin, muscles and intestines are particularly common in relapse.^[1]

Morphologic Features

Blood smears in T-PLL typically reveal anemia, thrombocytopenia, and leukocytosis, with atypical lymphocytes in three morphological forms: The most common form (75% of cases) features medium-sized cells with a high nuclear-to-cytoplasmic ratio, moderately condensed chromatin, a single visible nucleolus, and slightly basophilic cytoplasm. In 20% of cases, the cells appear as a small cell variant with densely condensed chromatin and an inconspicuous nucleolus. About 5% of cases exhibit a cerebriform variant with irregular nuclei resembling those in mycosis fungoides. Regardless of the nuclear features, a common morphological characteristic is the presence of cytoplasmic protrusions or blebs.^[3]Bone marrow aspirates show clusters of these neoplastic cells, with a mixed pattern of involvement including diffuse and interstitial, in trephine core biopsy.^[2]

Immunophenotype

Cytochemistry: T-cell prolymphocytes show strong staining with alpha-naphthyl acetate esterase and acid phosphatase, presenting a distinctive dot-like pattern, but cytochemistry is not commonly used for diagnosis.^[4]

Immunophenotype: T-cell prolymphocytes exhibit a post-thymic T-cell phenotype. In 60% of cases, the cells are CD4+ and CD8-. In 25% of cases, they co-express both CD4 and CD8, while the remaining 15% are CD4- and CD8+.^[5]

Finding	Marker
Positive (universal)	cyTCL1 (highest specificity), CD2, CD3 (may be weak), CD5, CD7 (strong), TCR-α/β, S100 (30% of cases)
Positive (subset)	CD4 (in some cases CD4+/CD8+ or CD4-/CD8+), CD52 (usually expressed at high density, therapeutic target), activation markers are variable (CD25, CD38, CD43, CD26, CD27)
Negative (universal)	TdT, CD1a, CD57, CD16, HTLV1
Negative (subset)	CD8 (in some cases CD4+/CD8+ or CD4-/CD8+)

Chromosomal Rearrangements (Gene Fusions)

Rearrangements involving the TCL1 (T-cell leukemia/lymphoma 1) family genes—TCL1A, MTCP1 (mature T-cell proliferation), or TCL1B (also known as TCL1/MTCP1-like 1 [TML1])—are highly specific to T-PLL and occur in more than 90% of cases. These translocations juxtapose the TRA locus with the oncogenes TCL1A or TCL1B, or in the case of t(X;14), with the MTCP1 gene.^[2]^[5]

Chromosomal Rearrangement	Genes in Fusion (5’ or 3’ Segments)	Pathogenic Derivative	Prevalence	Diagnostic Significance (Yes, No or Unknown)	Prognostic Significance (Yes, No or Unknown)	Therapeutic Significance (Yes, No or Unknown)	Notes
inv(14)(q11.2q32.1) t(14;14)(q11.2;q32.1)	TCL1A/B ,TRD		inv(14) ~60% t(14;14) ~25%	Yes	Yes	Yes	These genetic abnormalities serve as diagnostic markers and generally indicate an aggressive disease. This is due to their role in overexpressing oncogenes like TCL1A. Major diagnostic criteria.^[2]
t(X;14)(q28;q11.2)	MTCP1, TRD		Low (5%)	Yes	No	Yes	Major diagnostic criteria.^[2]

Individual Region Genomic Gain / Loss / LOH

Approximately 70-80% of T-PLL karyotypes are complex, which is considered minor diagnostic criteria, and usually include 3-5 or more structural aberrations. Common cytogenetic abnormalities include those of chromosome 8, such as idic(8)(p11.2), t(8;8)(p11.2;q12), and trisomy 8q. Other frequent changes are deletions in 12p13 and 22q, gains in 8q24 (MYC), and abnormalities in chromosomes 5p, 6, and 17.^[1]

Table: A list of clinically significant and/or recurrent CNAs and CN-LOH with potential or strong diagnostic, prognostic and treatment implications in T-PLL are listed below.

Chr #	Gain / Loss / Amp / LOH	Minimal Region Genomic Coordinates [Genome Build]	Minimal Region Cytoband	Diagnostic Significance (Yes, No or Unknown)	Prognostic Significance (Yes, No or Unknown)	Therapeutic Significance (Yes, No or Unknown)	Notes
8	Gain	idic(8)(p11) t(8;8)(p11;q12) trisomy 8q 8q24 (MYC)	idic(8)(p11.2) t(8;8)(p11.2;q12) trisomy 8q 8q24 (MYC)	Yes	No	No	Recurrent secondary finding (70-80% of cases). Minor diagnostic criteria.^[2]
5	Abnormality	5p, 5q ^[6]		Yes	Yes	No	Minor diagnostic criteria.^[2]
6	Abnormality	gain of 6p, loss of 6q ^[7]		No	No	No
11	Loss	11q	ch11q21-q23.3	Yes	Yes	Yes	Frequent, Minor diagnostic criteria.^[2]
12	Loss	12p	12p13	Yes	Yes	No	Haploinsufficiency of the CDKN1B gene at the 12p13 locus contributes to the development of T-PLL.^[8] Minor diagnostic criteria.^[2]
13	Loss	13q	13q14.3	Yes	No	No	Minor diagnostic criteria.^[2]
17	Abnormality	17p, 17q	17p13	No	Yes	Yes (resistance to therapy)	The TP53 gene is deleted (at 17p13.1), with overexpression of p53, in some cases. ^[5]
22	Loss	Monosomy 22 del(22q)	22q11-12 ^[9]^[10] (most common)	Yes	No	No	Leading to the dysregulation of genes such as BCL11B, which is crucial in T-cell development and function.^[10] Minor diagnostic criteria.^[2]

Diagnostic criteria

Diagnosis requires either all three major criteria or the first two major criteria along with one minor criterion:^[1]

Major criteria:
- 5 x 10⁹/L cells of T PLL phenotype in peripheral blood or bone marrow
- T cell clonality by molecular or flow cytometry methods
- Abnormalities of 14q32 or Xq28 or expression of TCL1A/B or MTC
Minor criteria:
- Abnormalities involving chromosome 11
- Abnormalities in chromosome 8
- Abnormalities in chromosome 5, 12, 13, 22 or complex karyotype
- Involvement of specific sites (spleen, effusions)

Characteristic Chromosomal Patterns

Inv(14)(q11.2q32)

The most common chromosomal abnormality in T-PLL involves an inversion of chromosome 14, with breakpoints at q11.2 and q32.1, observed in about 60-80% of patients and described as inv(14). Additionally, in 10-20% of cases, there is a translocation t(14;14)(q11.2;q32.1).^[1] ^[5]

Chromosomal Pattern	Diagnostic Significance (Yes, No or Unknown)	Prognostic Significance (Yes, No or Unknown)	Therapeutic Significance (Yes, No or Unknown)	Notes
inv(14)(q11q32) t(14;14)(q11.2;q32.1)	Yes	Yes	Yes	The most common chromosomal abnormality in T-PLL involves an inversion of chromosome 14, with breakpoints at q11.2 and q32.1, observed in about 60-80% of patients and described as inv(14). Additionally, in 10-20% of cases, there is a translocation t(14;14)(q11.2;q32.1)

Gene Mutations (SNV / INDEL)

Although gene mutations beyond TCL1 family alterations are not yet recognized as diagnostic criteria and remain under investigation for T-PLL, the mutational landscape of T-PLL provides valuable insights. These discoveries open up potential avenues for novel targeted therapies in treating this aggressive form of leukemia. As deletions and mutations of the ATM gene, present in up to 90% of T-PLL cases but typically absent in other mature T-cell malignancies, they are considered highly indicative in diagnosing suspected TCL1 family-negative T-PLL. ^[11]^[12]

Gene; Genetic Alteration	Presumed Mechanism (Tumor Suppressor Gene [TSG] / Oncogene / Other)	Prevalence (COSMIC / TCGA / Other)	Concomitant Mutations	Mutually Exclusive Mutations	Diagnostic Significance (Yes, No or Unknown)	Prognostic Significance (Yes, No or Unknown)	Therapeutic Significance (Yes, No or Unknown)	Notes
ATM	TSG	53% (COSMIC)	ATM mutation/deletion	None specified	Yes	Yes	Yes (PARP inhibitors, NCT03263637)	Since deletions of or missense mutations at the ATM locus are found in up to 80% to 90% of T-PLL cases, ATM alterations can serve as a minor diagnostic criterion.^[2]^[11]
FBXW10	TSG	72% (COSMIC)	JAK/STAT pathway	None specified	Unknown	Unknown	Unknown
IL2RG, JAK1, JAK3, STAT5B	Oncogene	8% JAK1 34% JAK3 16% STAT5B 2% IL2RG (COSMIC) (cumulative prevalence of ~ 60%)^[13]	ATM, TP53, Epigenetic modifiers ^[14]^[15]	Typically, mutations within this pathway occur in a mutually exclusive manner.^[12]	Yes	Yes	Yes	Targeting this pathway with specific JAK/STAT pathway inhibitors, such as tofacitinib, has shown promise in preclinical studies and early clinical trials. Combining JAK/STAT inhibitors with other treatments, like BCL-2 inhibitors, may enhance therapeutic efficacy and improve outcomes for T-PLL patients^[16]^[17]
EZH2	Oncogene, TSG	16% (COSMIC)	JAK/STAT pathway^[14]^[15]	None specified	No	Yes	See note	EZH2 inhibitors like tazemetostat have shown efficacy in other hematologic malignancies, providing a rationale for their potential use in T-PLL
BCOR	TSG	8% (COSMIC)	JAK/STAT pathway^[14]^[15]	None specified	No	No (see note)	No	A negative impact on overall survival (OS) was not observed for T-PLL patients in the study. However, this might be attributable to the relatively low number of cases compared to studies on AML and MDS.^[18]
SAMHD1	TSG	~7-20%^[11]^[19]	None specified	None specified	Yes	Yes	No	SAMHD1 mutations may indicate a defective DNA damage response and aggressive disease ^[19]
CHEK2	TSG	5% (COSMIC)	ATM, TP53, JAK/STAT pathway, Epigenetic modifiers	None specified	No	Yes	No	CHEK2 mutations may indicate a defective DNA damage response and aggressive disease ^[12]^[20]
TP53	TSG	2% (COSMIC)	ATM, JAK/STAT pathway, Epigenetic modifiers	None specified-In a study of T-PLL case, TP53 mutations were predominantly found in patients lacking TCRA/D rearrangements.^[18]	No	Yes	Associated with resistance to therapy	Mutations in TP53 are less frequent than deletions.^[18]

Note: A more extensive list of mutations can be found in cBioportal (https://www.cbioportal.org/), COSMIC (https://cancer.sanger.ac.uk/cosmic), ICGC (https://dcc.icgc.org/) and/or other databases. When applicable, gene-specific pages within the CCGA site directly link to pertinent external content.

Epigenomic Alterations

Research indicates that epigenetic modifications in the regulatory regions of key oncogenes and genes involved in DNA damage response and T-cell receptor regulation are clearly present. These changes are closely associated with the transcriptional dysregulation that forms the core lesions of T-PLL.^[21]

Genes and Main Pathways Involved

The key pathways involved in the pathogenesis of T-cell prolymphocytic leukemia (T-PLL) include DNA damage repair, T-cell receptor (TCR) signaling, and epigenetic modulation. Additionally, there is frequent mutational activation of the IL2RG-JAK1-JAK3-STAT5B pathway, which plays a significant role in the disease's development and progression.^[2]

Gene; Genetic Alteration	Pathway	Pathophysiologic Outcome
TCL1A/B rearrangement	AKT signaling and TCR signal amplification pathways	Increased cell survival and proliferation
MTCP1	AKT signaling and TCR signal amplification pathways	Increased cell survival and proliferation
ATM, CHEK2	DNA damage repair pathway	Genomic instability
JAK1, JAK3, STAT5B	JAK-STAT pathway	Unchecked cell growth and survival
IL2RG	JAK-STAT pathway, Cytokine signaling	Promoting lymphocyte proliferation
EZH2	Transcription regulator	Altering the epigenetic landscape

Genetic Diagnostic Testing Methods

Cytogenetics (FISH, CpG-stimulated Karyotype, SNP microarray), PCR for TRB/TRG and Next-Generation Sequencing (NGS). The genetic diagnostic process involves detecting clonal rearrangements of the TR gene and rearrangements of the TCL1 gene at the TRB or TRG loci.

Familial Forms

While there is no noticeable familial clustering of T-cell prolymphocytic leukemia (T-PLL), a subset of cases can develop in the context of ataxia-telangiectasia (AT). AT is characterized by germline mutations in the ATM gene, and patients with AT are at an increased risk for various malignancies, including T-PLL. In these cases, biallelic inactivation of the ATM tumor suppressor gene occurs, with about 10% to 15% penetrance of the tumor phenotype by early adulthood. T-PLL represents nearly 3% of all malignancies in patients with ataxia-telangiectasia. ^[22] ^[23] ^[24]

Additional Information

In T-PLL, the rapid growth of the disease necessitates immediate initiation of treatment. The most effective first-line treatment is alemtuzumab, an anti-CD52 antibody with remission rates over 80%. However, these remissions usually last only 1-2 years. To potentially extend remission, eligible patients are advised to undergo allogeneic blood stem cell transplantation (allo-SCT) during their first complete remission, which can lead to longer remission durations of over 4-5 years for 15-30% of patients. Consequently, the prognosis for T-PLL remains poor, with median overall survival times under two years and five-year survival rates below 5%. Ongoing studies are exploring molecularly targeted drugs and signaling pathway inhibitors, for routine clinical use in treating T-PLL.

Links

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References

↑ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Elenitoba-Johnson K, et al. T-prolymphocytic leukemia. In: WHO Classification of Tumours Editorial Board. Haematolymphoid tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2024 [cited 2024 June 12]. (WHO classification of tumors series, 5th ed.; vol. 11). Available from: https://tumourclassification.iarc.who.int/chaptercontent/63/209
↑ ^2.00 ^2.01 ^2.02 ^2.03 ^2.04 ^2.05 ^2.06 ^2.07 ^2.08 ^2.09 ^2.10 ^2.11 ^2.12 Staber, Philipp B.; et al. (2019-10-03). "Consensus criteria for diagnosis, staging, and treatment response assessment of T-cell prolymphocytic leukemia". Blood. 134 (14): 1132–1143. doi:10.1182/blood.2019000402. ISSN 1528-0020. PMC 7042666 Check |pmc= value (help). PMID 31292114.
↑ Gutierrez, Marc; et al. (2023-07-28). "T-Cell Prolymphocytic Leukemia: Diagnosis, Pathogenesis, and Treatment". International Journal of Molecular Sciences. 24 (15): 12106. doi:10.3390/ijms241512106. ISSN 1422-0067. PMC PMC10419310 Check |pmc= value (help). PMID 37569479 Check |pmid= value (help).CS1 maint: PMC format (link)
↑ Yang, K.; et al. (1982-08). "Acid phosphatase and alpha-naphthyl acetate esterase in neoplastic and non-neoplastic lymphocytes. A statistical analysis". American Journal of Clinical Pathology. 78 (2): 141–149. doi:10.1093/ajcp/78.2.141. ISSN 0002-9173. PMID 6179423. Check date values in: |date= (help)
↑ ^5.0 ^5.1 ^5.2 ^5.3 Matutes E, et al., (2017). T-cell prolymphocytic leukemia, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. Revised 4th Edition. IARC Press: Lyon, France, p346-347.
↑ Tirado, Carlos A.; et al. (2012-08-20). ""T-cell prolymphocytic leukemia (T-PLL), a heterogeneous disease exemplified by two cases and the important role of cytogenetics: a multidisciplinary approach"". Experimental Hematology & Oncology. 1 (1): 21. doi:10.1186/2162-3619-1-21. ISSN 2162-3619. PMC 3514161. PMID 23211026.
↑ Dearden, Claire (2012-07-19). "How I treat prolymphocytic leukemia". Blood. 120 (3): 538–551. doi:10.1182/blood-2012-01-380139. ISSN 1528-0020. PMID 22649104.
↑ Le Toriellec, Emilie; et al. (2008-02-15). "Haploinsufficiency of CDKN1B contributes to leukemogenesis in T-cell prolymphocytic leukemia". Blood. 111 (4): 2321–2328. doi:10.1182/blood-2007-06-095570. ISSN 0006-4971. PMID 18073348.
↑ Stengel, Anna; et al. (2014-12-06). "A Comprehensive Cytogenetic and Molecular Genetic Characterization of Patients with T-PLL Revealed Two Distinct Genetic Subgroups and JAK3 Mutations As an Important Prognostic Marker". Blood. 124 (21): 1639–1639. doi:10.1182/blood.v124.21.1639.1639. ISSN 0006-4971.
↑ ^10.0 ^10.1 Fang, Hong; et al. (2023-09). "T-prolymphocytic leukemia: TCL1 or MTCP1 rearrangement is not mandatory to establish diagnosis". Leukemia. 37 (9): 1919–1921. doi:10.1038/s41375-023-01956-3. ISSN 1476-5551. PMID 37443196 Check |pmid= value (help). Check date values in: |date= (help)
↑ ^11.0 ^11.1 ^11.2 Schrader, A.; et al. (2018-02-15). "Actionable perturbations of damage responses by TCL1/ATM and epigenetic lesions form the basis of T-PLL". Nature Communications. 9 (1): 697. doi:10.1038/s41467-017-02688-6. ISSN 2041-1723. PMC 5814445. PMID 29449575.
↑ ^12.0 ^12.1 ^12.2 Kiel, Mark J.; et al. (2014-08-28). "Integrated genomic sequencing reveals mutational landscape of T-cell prolymphocytic leukemia". Blood. 124 (9): 1460–1472. doi:10.1182/blood-2014-03-559542. ISSN 1528-0020. PMC 4148768. PMID 24825865.
↑ Wahnschaffe, Linus; et al. (2019-11-21). "JAK/STAT-Activating Genomic Alterations Are a Hallmark of T-PLL". Cancers. 11 (12): 1833. doi:10.3390/cancers11121833. ISSN 2072-6694. PMC 6966610. PMID 31766351.
↑ ^14.0 ^14.1 ^14.2 Andersson, E. I.; et al. (2018-03). "Discovery of novel drug sensitivities in T-PLL by high-throughput ex vivo drug testing and mutation profiling". Leukemia. 32 (3): 774–787. doi:10.1038/leu.2017.252. ISSN 1476-5551. PMID 28804127. Check date values in: |date= (help)
↑ ^15.0 ^15.1 ^15.2 Pinter-Brown, Lauren C. (2021-12-30). "JAK/STAT: a pathway through the maze of PTCL?". Blood. 138 (26): 2747–2748. doi:10.1182/blood.2021014238. ISSN 0006-4971.
↑ Gomez-Arteaga, Alexandra; et al. (2019-07). "Combined use of tofacitinib (pan-JAK inhibitor) and ruxolitinib (a JAK1/2 inhibitor) for refractory T-cell prolymphocytic leukemia (T-PLL) with a JAK3 mutation". Leukemia & Lymphoma. 60 (7): 1626–1631. doi:10.1080/10428194.2019.1594220. ISSN 1029-2403. PMC 8162842 Check |pmc= value (help). PMID 30997845. Check date values in: |date= (help)
↑ . doi:10.1182/blood.v126.23.5486.5486 https://ashpublications.org/blood/article/126/23/5486/134544/Refractory-TCell-Prolymphocytic-Leukemia-with-JAK3. Missing or empty |title= (help)
↑ ^18.0 ^18.1 ^18.2 Stengel, Anna; et al. (2016-01). "Genetic characterization of T-PLL reveals two major biologic subgroups and JAK3 mutations as prognostic marker". Genes, Chromosomes & Cancer. 55 (1): 82–94. doi:10.1002/gcc.22313. ISSN 1098-2264. PMID 26493028. Check date values in: |date= (help)
↑ ^19.0 ^19.1 Johansson, Patricia; et al. (2018-01-19). "SAMHD1 is recurrently mutated in T-cell prolymphocytic leukemia". Blood Cancer Journal. 8 (1): 11. doi:10.1038/s41408-017-0036-5. ISSN 2044-5385. PMC 5802577. PMID 29352181.
↑ Braun, Till; et al. (2021). "Advanced Pathogenetic Concepts in T-Cell Prolymphocytic Leukemia and Their Translational Impact". Frontiers in Oncology. 11: 775363. doi:10.3389/fonc.2021.775363. ISSN 2234-943X. PMC 8639578 Check |pmc= value (help). PMID 34869023 Check |pmid= value (help).
↑ Tian, Shulan; et al. (2021-04-15). "Epigenetic alteration contributes to the transcriptional reprogramming in T-cell prolymphocytic leukemia". Scientific Reports. 11 (1): 8318. doi:10.1038/s41598-021-87890-9. ISSN 2045-2322. PMC 8050249 Check |pmc= value (help). PMID 33859327 Check |pmid= value (help).
↑ Suarez, Felipe; et al. (2015-01-10). "Incidence, presentation, and prognosis of malignancies in ataxia-telangiectasia: a report from the French national registry of primary immune deficiencies". Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology. 33 (2): 202–208. doi:10.1200/JCO.2014.56.5101. ISSN 1527-7755. PMID 25488969.
↑ Taylor, A. M.; et al. (1996-01-15). "Leukemia and lymphoma in ataxia telangiectasia". Blood. 87 (2): 423–438. ISSN 0006-4971. PMID 8555463.
↑ Li, Geling; et al. (2017-12-26). "T-cell prolymphocytic leukemia in an adolescent with ataxia-telangiectasia: novel approach with a JAK3 inhibitor (tofacitinib)". Blood Advances. 1 (27): 2724–2728. doi:10.1182/bloodadvances.2017010470. ISSN 2473-9529. PMC 5745136. PMID 29296924.

Notes

*Primary authors will typically be those that initially create and complete the content of a page. If a subsequent user modifies the content and feels the effort put forth is of high enough significance to warrant listing in the authorship section, please contact the CCGA coordinators (contact information provided on the homepage). Additional global feedback or concerns are also welcome.

[:5-1] 1.0 ^1.1 ^1.2 ^1.3 ^1.4 ^1.5 ^1.6 Elenitoba-Johnson K, et al. T-prolymphocytic leukemia. In: WHO Classification of Tumours Editorial Board. Haematolymphoid tumours [Internet]. Lyon (France): International Agency for Research on Cancer; 2024 [cited 2024 June 12]. (WHO classification of tumors series, 5th ed.; vol. 11). Available from: https://tumourclassification.iarc.who.int/chaptercontent/63/209

[:6-2] 2.00 ^2.01 ^2.02 ^2.03 ^2.04 ^2.05 ^2.06 ^2.07 ^2.08 ^2.09 ^2.10 ^2.11 ^2.12 Staber, Philipp B.; et al. (2019-10-03). "Consensus criteria for diagnosis, staging, and treatment response assessment of T-cell prolymphocytic leukemia". Blood. 134 (14): 1132–1143. doi:10.1182/blood.2019000402. ISSN 1528-0020. PMC 7042666 Check |pmc= value (help). PMID 31292114.

[3] Gutierrez, Marc; et al. (2023-07-28). "T-Cell Prolymphocytic Leukemia: Diagnosis, Pathogenesis, and Treatment". International Journal of Molecular Sciences. 24 (15): 12106. doi:10.3390/ijms241512106. ISSN 1422-0067. PMC PMC10419310 Check |pmc= value (help). PMID 37569479 Check |pmid= value (help).CS1 maint: PMC format (link)

[4] Yang, K.; et al. (1982-08). "Acid phosphatase and alpha-naphthyl acetate esterase in neoplastic and non-neoplastic lymphocytes. A statistical analysis". American Journal of Clinical Pathology. 78 (2): 141–149. doi:10.1093/ajcp/78.2.141. ISSN 0002-9173. PMID 6179423. Check date values in: |date= (help)

[:7-5] 5.0 ^5.1 ^5.2 ^5.3 Matutes E, et al., (2017). T-cell prolymphocytic leukemia, in World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. Revised 4th Edition. IARC Press: Lyon, France, p346-347.

[6] Tirado, Carlos A.; et al. (2012-08-20). ""T-cell prolymphocytic leukemia (T-PLL), a heterogeneous disease exemplified by two cases and the important role of cytogenetics: a multidisciplinary approach"". Experimental Hematology & Oncology. 1 (1): 21. doi:10.1186/2162-3619-1-21. ISSN 2162-3619. PMC 3514161. PMID 23211026.

[7] Dearden, Claire (2012-07-19). "How I treat prolymphocytic leukemia". Blood. 120 (3): 538–551. doi:10.1182/blood-2012-01-380139. ISSN 1528-0020. PMID 22649104.

[8] Le Toriellec, Emilie; et al. (2008-02-15). "Haploinsufficiency of CDKN1B contributes to leukemogenesis in T-cell prolymphocytic leukemia". Blood. 111 (4): 2321–2328. doi:10.1182/blood-2007-06-095570. ISSN 0006-4971. PMID 18073348.

[9] Stengel, Anna; et al. (2014-12-06). "A Comprehensive Cytogenetic and Molecular Genetic Characterization of Patients with T-PLL Revealed Two Distinct Genetic Subgroups and JAK3 Mutations As an Important Prognostic Marker". Blood. 124 (21): 1639–1639. doi:10.1182/blood.v124.21.1639.1639. ISSN 0006-4971.

[:0-10] 10.0 ^10.1 Fang, Hong; et al. (2023-09). "T-prolymphocytic leukemia: TCL1 or MTCP1 rearrangement is not mandatory to establish diagnosis". Leukemia. 37 (9): 1919–1921. doi:10.1038/s41375-023-01956-3. ISSN 1476-5551. PMID 37443196 Check |pmid= value (help). Check date values in: |date= (help)

[:8-11] 11.0 ^11.1 ^11.2 Schrader, A.; et al. (2018-02-15). "Actionable perturbations of damage responses by TCL1/ATM and epigenetic lesions form the basis of T-PLL". Nature Communications. 9 (1): 697. doi:10.1038/s41467-017-02688-6. ISSN 2041-1723. PMC 5814445. PMID 29449575.

[:3-12] 12.0 ^12.1 ^12.2 Kiel, Mark J.; et al. (2014-08-28). "Integrated genomic sequencing reveals mutational landscape of T-cell prolymphocytic leukemia". Blood. 124 (9): 1460–1472. doi:10.1182/blood-2014-03-559542. ISSN 1528-0020. PMC 4148768. PMID 24825865.

[13] Wahnschaffe, Linus; et al. (2019-11-21). "JAK/STAT-Activating Genomic Alterations Are a Hallmark of T-PLL". Cancers. 11 (12): 1833. doi:10.3390/cancers11121833. ISSN 2072-6694. PMC 6966610. PMID 31766351.

[:1-14] 14.0 ^14.1 ^14.2 Andersson, E. I.; et al. (2018-03). "Discovery of novel drug sensitivities in T-PLL by high-throughput ex vivo drug testing and mutation profiling". Leukemia. 32 (3): 774–787. doi:10.1038/leu.2017.252. ISSN 1476-5551. PMID 28804127. Check date values in: |date= (help)

[:2-15] 15.0 ^15.1 ^15.2 Pinter-Brown, Lauren C. (2021-12-30). "JAK/STAT: a pathway through the maze of PTCL?". Blood. 138 (26): 2747–2748. doi:10.1182/blood.2021014238. ISSN 0006-4971.

[16] Gomez-Arteaga, Alexandra; et al. (2019-07). "Combined use of tofacitinib (pan-JAK inhibitor) and ruxolitinib (a JAK1/2 inhibitor) for refractory T-cell prolymphocytic leukemia (T-PLL) with a JAK3 mutation". Leukemia & Lymphoma. 60 (7): 1626–1631. doi:10.1080/10428194.2019.1594220. ISSN 1029-2403. PMC 8162842 Check |pmc= value (help). PMID 30997845. Check date values in: |date= (help)

[17] . doi:10.1182/blood.v126.23.5486.5486 https://ashpublications.org/blood/article/126/23/5486/134544/Refractory-TCell-Prolymphocytic-Leukemia-with-JAK3. Missing or empty |title= (help)

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[:4-19] 19.0 ^19.1 Johansson, Patricia; et al. (2018-01-19). "SAMHD1 is recurrently mutated in T-cell prolymphocytic leukemia". Blood Cancer Journal. 8 (1): 11. doi:10.1038/s41408-017-0036-5. ISSN 2044-5385. PMC 5802577. PMID 29352181.

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[21] Tian, Shulan; et al. (2021-04-15). "Epigenetic alteration contributes to the transcriptional reprogramming in T-cell prolymphocytic leukemia". Scientific Reports. 11 (1): 8318. doi:10.1038/s41598-021-87890-9. ISSN 2045-2322. PMC 8050249 Check |pmc= value (help). PMID 33859327 Check |pmid= value (help).

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[23] Taylor, A. M.; et al. (1996-01-15). "Leukemia and lymphoma in ataxia telangiectasia". Blood. 87 (2): 423–438. ISSN 0006-4971. PMID 8555463.

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