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Hepatosplenic gammadelta T-cell lymphoma successfully treated with a combination of alemtuzumab and cladribine.

A 41-year-old female patient suffering from fatigue due to haemolytic Coombs-negative anaemia was admitted to our department in November 2001. Computed tomography scans and sonography solely displayed a marginal hepatosplenomegaly. Bone marrow trephine biopsy (BM-TB) revealed a hypercellular marrow presenting few small nodular lymphomatous infiltrates, >50% reactive with antibodies to CD19, CD20, CD21 and bcl2. Also, numerous CD3-positive T cells, but no monoclonal T-cell receptor (TCR) rearrangement could be detected initially. Using primers for the immunoglobulin heavy chain rearrangement, a slight band was detected suggestive of B-cell monoclonality. Together with the morphology of the infiltrate, follicular lymphoma was hypothesised. Cytogenetics revealed a normal female chromosomal pattern. The follicular lymphoma international prognostic index was judged as high risk. Consequently, three cycles of R-CHOP (rituximab– cyclophosphamide–doxorubicin–vincristine–prednisolone) were administered leading to a good partial remission. None the less, transfusion-dependent haemolytic anaemia and neutropenia reoccurred 1 year later and was symptomatically treated by repetitive red blood cell transfusions—108 units within 1 year. Concomitantly, massive hepatosplenomegaly in conjunction with B-type symptoms developed. At that time, the BM-TB showed a hypercellular marrow with multiple nodular lymphomatous infiltrates revealing the typical hepatosplenic gammadelta (cd) T-cell lymphoma-specific phenotype: CD2+, CD3+, CD4-, CD5-, CD7+, CD8and a bright CD52 positivity. PCR-based analysis of the TCR cd chain rearrangement by two