T-cell large granular lymphocytic leukemia

T-cell large granular lymphocytic (TLGL) leukemia is a rare lymphoproliferative disorder that starts in T cells (a type of lymphocyte). Lymphoproliferative means that the bone marrow makes large numbers of lymphocytes. TLGL leukemia is usually slow growing (indolent). In rare cases, TLGL leukemia can be fast growing (aggressive).

TLGL leukemia can develop at any age, but it most often occurs in older adults. The average age at diagnosis is about 60.

Many people who develop TLGL leukemia have a history of rheumatoid arthritis or another autoimmune disease (a disorder that causes the immune system to attack the body’s own tissue).


Some people with TLGL leukemia do not have any symptoms. If TLGL leukemia affects the bone marrow, it can cause recurring infections and lower than normal numbers of blood cells. When it affects the spleen and liver, they may become larger than normal. It rarely causes lymph nodes to become larger than normal.


The treatments offered for TLGL leukemia depend on if the disease is causing symptoms or other problems. Although TLGL leukemia is usually slow growing (indolent), most people need treatment because they have low blood cell counts.

Watchful waiting

Watchful waiting (also called active surveillance) may be an option if you don’t have any symptoms. The healthcare team carefully monitors you and will start treatment if TLGL leukemia progresses or you develop symptoms, such as discomfort from a larger than normal spleen, very low blood cell counts or recurring infections.

Chemotherapy and other drugs

The main treatment for TLGL leukemia is chemotherapy and other drugs. The chemotherapy drugs include:

  • low-dose methotrexate
  • cyclophosphamide (Cytoxan, Procytox)

An immunosuppressant drug used to treat TLGL leukemia is cyclosporine (Neoral).

Each of these drugs may be used in combination with prednisone.

CHOP is a combination of chemotherapy drugs commonly used to treat NHL. It may be used to treat TLGL leukemia. The drugs used in CHOP are:

  • cyclophosphamide
  • doxorubicin (Adriamycin)
  • vincristine (Oncovin)
  • prednisone

Expert review and references

  • American Cancer Society. Leukemia - Chronic Lymphocytic. Atlanta, GA: American Cancer Society; 2013: http://www.cancer.org/acs/groups/cid/documents/webcontent/003111-pdf.pdf.
  • National Cancer Institute. Chronic lymphocytic leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • Wierda WG, O'Brien SM . Chronic lymphocytic leukemias. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 110: 1654 - 1670.