Gibson Stuart K, Davis Thomas, Vazquez Melisa, Htet Swe, Wong Eric
Clinical Haematology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.
Anatomical Pathology, Austin Health, Heidelberg, Victoria, Australia.
Case Rep Hematol. 2025 Aug 29;2025:1402078. doi: 10.1155/crh/1402078. eCollection 2025.
T-cell prolymphocytic leukaemia (T-PLL) is an aggressive and rare post-thymic T cell malignancy, highly refractory to conventional cytotoxic chemotherapeutics. While extranodal involvement is common, solid organ invasion is rare. We present the case of a 76-year-old man who developed acute renal failure secondary to T-PLL renal infiltration. On day four of his admission, prior to commencing alemtuzumab, his creatinine rose from 133 μmol/L to 390 μmol/L, with anuria. Renal biopsy demonstrated an infiltrate of monomorphic, mononuclear cells positive for a STAT5B mutation, consistent with T-PLL infiltration. He required haemodialysis, but was treated with pulsed methylprednisolone and alemtuzumab, with excellent renal recovery, although remission was not achieved. This case demonstrates that renal leukaemic infiltration must be considered in T-PLL patients with rapidly progressive renal failure, and that solid organ invasion should not contraindicate timely commencement of T-PLL-directed therapy with alemtuzumab.
T细胞原淋巴细胞白血病（T-PLL）是一种侵袭性且罕见的胸腺后T细胞恶性肿瘤，对传统细胞毒性化疗药物高度耐药。虽然结外受累很常见，但实体器官侵犯很少见。我们报告一例76岁男性患者，因T-PLL肾浸润继发急性肾衰竭。入院第4天，在开始使用阿仑单抗之前，他的肌酐从133μmol/L升至390μmol/L，出现无尿。肾活检显示单形性单核细胞浸润，STAT5B突变呈阳性，符合T-PLL浸润。他需要血液透析，但接受了脉冲式甲泼尼龙和阿仑单抗治疗，肾功能恢复良好，尽管未实现缓解。该病例表明，对于T-PLL合并快速进展性肾衰竭的患者，必须考虑肾白血病浸润，实体器官侵犯不应成为及时开始使用阿仑单抗进行T-PLL定向治疗的禁忌证。
