BSH 2023 | Challenges with diagnosing mature T-cell leukemias

There are challenges in diagnosing the mature T-cell leukemias. Firstly, because as a group of leukemias they’re quite rare and so in individual hospitals we won’t expect to see that many each year. There are certain characteristics for the T-cell leukemias that are quite characteristic for that particular type. So, for example, the patient that has ATLL, for example, often will have hypercalcemia, which we wouldn’t see in T-PLL, those patients that have got an accessory syndrome or cutaneous T-cell lymphoma with leukemic involvement, will obviously have the skin rashes associated with it. So, there can be very typical patients that behave as per the textbook kind of examples of those leukemias. But then there will be more tricky cases where they present in very different ways, not your typical way. Also, we’ve got the added complexity that some of our nodal T-cell lymphomas can present in a leukemic phase that can also add to the difficulty. So, I think just this is reflective probably of the heterogeneity of T-cell lymphomas and leukemias in general, that it’s not that we can do one single test or one single thing that will absolutely diagnose it, that we have to use everything, all our armamentarium to be able to come up with the diagnosis for the patient. So, by that I mean looking at the morphology, looking at the clinical picture, any genetic information, any cytogenetic information, and it’s putting everything together. So certainly, where I work at the Royal Marsden, I work very closely with the histopathologists but they can’t make the diagnosis alone. We have to work in combination with the genetic information and I think this was highlighted in the talk here at BSH by Professor De Jong when talking about that hierarchical diagnosis of malignancies in general.