Four women and three men after allogeneic (n ¼ 4) and autologous (n ¼ 3) haematopoietic SCT (HSCT) were observed to have an increase in T-cell large granular lymphocytes (T-LGLs) of CD3 þ CD8 þ phenotype for a median of 41 (15 --118) months. Clonal rearrangement of the T-cell receptor gene was verified by two PCR techniques and direct DNA sequencing, confirming that the cases were neoplastic and therefore classifiable as T-LGL leukaemia. In the allogeneic HSCT cases, T-LGL leukaemia was derived from donor T cells in three patients, as shown by DNA chimerism analysis, and recipient T cells in one patient who had graft failure previously. None of the patients showed cytopenia, autoimmune phenomenon or organ infiltration, which were features typical of de novo T-LGL leukaemia. Six patients had remained asymptomatic with stable large granular lymphocyte counts. One patient died from cerebral relapse of the original lymphoma. T-LGL leukaemias occurring post-HSCT are distinct from de novo T-LGL leukaemia and may have a different pathogenesis and clinical course. Patients did not require specific treatment, and the disease remained stable for long periods.Bone Marrow Transplantation (2012) 47, 952 --956;

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A 52-year-old woman presented with unremitting pyrexia reaching 40C. There was progressive weight loss and jaundice. A series of investigations failed to give a diagnosis, and because of rapid deterioration she was referred for management. On admission, she was moribund, with a fever of 40 C. There was marked pallor and jaundice. Abdominal examination showed gross hepatomegaly and splenomegaly (22 cm and 6 cm below the costal margin, respectively). A full blood count showed hemoglobin: 5.5 g/dL, white cell count: 1.42

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