Clinical features and influencing factors analysis of T-cell large granular lymphocytic leukemia complicated with pure red cell aplasia

Objective This study systematically characterized the key clinical features and influencing factors of patients with T-LGLL-PRCA, aiming to provide evidence to improve clinical diagnostic and therapeutic strategies. Methods Clinical characteristics were retrospectively compared between patients with T-LGLL-PRCA (n=15) and those without PRCA (T-LGLL–Non-PRCA, n=25). Risk factors for the development of T-LGLL-PRCA were evaluated using univariate and multivariate logistic regression analyses. Results This study retrospectively included a total of 40 patients with T-LGLL, of whom 15 were classified into the T-LGLL–PRCA group, accounting for one-third of the entire cohort. The median age of patients in the T-LGLL–PRCA group was 68 years, with a relatively high proportion aged ≥65 years, and the majority were female. The most common symptoms included fatigue, dizziness, and palpitations. The major comorbidity was thrombocytopenia. Positivity for EBV and ANA was frequently observed. Mutations in TET2 exon 11 and exon 3 were the most frequently detected genetic variants. At the molecular level, clonal rearrangements of the TCRβ and TCRγ genes were most commonly observed. Moreover, a substantial proportion of patients displayed a TCR γδ immunophenotype. Significant differences between groups were observed in circulating T-LGL count, Hemoglobin (HB), Hematocrit (HCT), Reticulocyte Count (RNC), Erythropoietin (EPO) levels >750 mIU/mL, and Immature Reticulocyte Fraction (IRF) ( P < 0.05). Univariate logistic regression suggested that HB ( OR :0.926; P = 0.003), HCT ( OR :0.837; P = 0.006), EPO levels>750 mIU/mL ( OR :7.071; P = 0.008), RNC ( OR :0.682; P = 0.027), and IRF ( OR :0.857; P = 0.007) were associated with T-LGLL-PRCA( P < 0.05). Multivariate analysis identified RNC ( OR :0.590; P = 0.048) as the sole independent influencing factor ( P < 0.05). Conclusion RNC is an independent influencing factor for the development of T-LGLL-PRCA.