case_images: PMC10601731_01
case_images: Findings at diagnosis. a Bone marrow smear showed an increase in abnormal lymphocytes with round nuclei, visible nucleoli, and non-granular basophilic cytoplasm. b Flow cytometric analysis of peripheral blood detected abnormal T lymphocytes. The search for membrane CD3 (mCD3) and cytoplasmic CD3 (cyCD3) demonstrates that the major clones (red: 94.6%) display the aberrant mCD3(-), cyCD3(+) phenotype, whereas the minor clones (blue: 0.1%, green: 0.8%) display the mCD3(+), cyCD3(+) and mCD3(-), cyCD3(-) phenotype, respectively. c G-banding cytogenetic analysis of bone marrow aspirate showed complex karyotype with multiple chromosomal aberrations: 46,XY,add(1)(p11),?del(1)(q?),add(3)(q21),add(11)(q13),inc. d CT showed splenomegaly and lymphadenopathy.
case_images: cro-2023-0016-0001-531471_F01.jpg
case_images: PMC10601731_01_cro-2023-0016-0001-531471_F01.jpg
case_images: F1
case_images: Laboratory tests revealed a white blood cell count of 430,800/mL (95.5% of which were abnormal lymphocytes with round nuclei, visible nucleoli, and non-granular basophilic cytoplasm) (Fig. 1a). Flow cytometric analysis of peripheral blood lymphocytes demonstrated an aberrant T-cell phenotype with post-thymic features, positive for CD2 and cytoplasmic CD3, CD4, CD5, CD7, CD45, CD52, and TCL1 and negative for membrane-associated CD3, CD8, CD19, CD20, CD25, CD34, CD56, CD79a, HLA-DR, and TdT (Fig. 1b). Cytogenetic analysis detected a complex karyotype (Fig. 1c). Computed tomography (CT) scanning revealed severe splenomegaly, systemic lymphadenopathy, and ascites (Fig. 1d).
case_images: Clinical course after transplantation. Changes in the number of peripheral white blood cells (WBC), neutrophils, and lymphocytes, as well as changes in body temperature during hospitalization, are shown. Flu, fludarabine; Mel, melphalan; Tac, tacrolimus; MMF, mycophenolate mofetil; PSL, prednisolone; aGVHD, acute graft-versus-host disease; FN, febrile neutropenia; CRBSI, catheter-related bloodstream infection; TB, tuberculosis; CMV, cytomegalovirus; FLCZ, fluconazole; ACV, acyclovir; ST, sulfamethoxazole and trimethoprim; LET letermovir, VGCV, valganciclovir.
case_images: cro-2023-0016-0001-531471_F02.jpg
case_images: PMC10601731_01_cro-2023-0016-0001-531471_F02.jpg
case_images: F2
case_images: Gy on day 1), was used. GVHD prophylaxis comprised PTCy (40 mg/kg on days 3 and 4), tacrolimus (initiated at a dose of 0.02 mg/kg from day 5), and mycophenolate mofetil (initiated at a dose of 30 mg/kg from day 5 and stopped on day 48) (Fig. 2).