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Felty's syndrome complicates T-cell large granular lymphocyte leukemia in RA

DESTIN, Fla. — The classical findings of the rare condition Felty’s syndrome, which include rheumatoid arthritis, splenomegaly and neutropenia, can make differentiating between Felty’s and T-cell large granular lymphocyte leukemia very difficult, according to Jonathan A. Aun, DO, of the Keesler Medical Center, at Keesler Air Force Base in Biloxi, Mississippi.

“Felty’s syndrome and T-LGL share a lot of commonalities between the two,” Aun told Healio Rheumatology. “Today I presented a case that showed these shared differences and the kind of conundrum that exists between these two diseases. Interestingly enough, our patient was on a first-line therapy with methotrexate when she developed this disease — that was probably the most important take-home message from her case.”

Other key aspects of this case, of a 78-year-old white woman with long-standing seropositive non-erosive RA, included that T-cell receptor (TCR) gene rearrangement revealed a clonal TCR gamma population, and that she responded to cyclophosphamide (Cytoxan, Bristol-Myers Squibb), which is considered to be a second-line agent for T-LGL, Aun said. He added that only 34% of patients with T-LGL respond to cyclophosphamide.

“All in all, this is a very difficult case to deal with,” Aun said. “Differentiating the two has been a common difficulty for many years, and many have actually said that these two diseases amalgamate within a common disease spectrum.”

Reference:

Aun JA. Felty’s syndrome conundrum: Large granular lymphocytic leukemia. Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Fla.

Disclosures : Aun reports no relevant financial disclosures.

DESTIN, Fla. — The classical findings of the rare condition Felty’s syndrome, which include rheumatoid arthritis, splenomegaly and neutropenia, can make differentiating between Felty’s and T-cell large granular lymphocyte leukemia very difficult, according to Jonathan A. Aun, DO, of the Keesler Medical Center, at Keesler Air Force Base in Biloxi, Mississippi.

“Felty’s syndrome and T-LGL share a lot of commonalities between the two,” Aun told Healio Rheumatology. “Today I presented a case that showed these shared differences and the kind of conundrum that exists between these two diseases. Interestingly enough, our patient was on a first-line therapy with methotrexate when she developed this disease — that was probably the most important take-home message from her case.”

Other key aspects of this case, of a 78-year-old white woman with long-standing seropositive non-erosive RA, included that T-cell receptor (TCR) gene rearrangement revealed a clonal TCR gamma population, and that she responded to cyclophosphamide (Cytoxan, Bristol-Myers Squibb), which is considered to be a second-line agent for T-LGL, Aun said. He added that only 34% of patients with T-LGL respond to cyclophosphamide.

“All in all, this is a very difficult case to deal with,” Aun said. “Differentiating the two has been a common difficulty for many years, and many have actually said that these two diseases amalgamate within a common disease spectrum.”

Reference:

Aun JA. Felty’s syndrome conundrum: Large granular lymphocytic leukemia. Presented at: Congress of Clinical Rheumatology; May 2-5, 2019; Destin, Fla.

Disclosures : Aun reports no relevant financial disclosures.

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