Evaluation of large ganular lymphocyte and hand mirror cell in leukemia patients in Isfahan province during 1993-1998

FAB (French – American- British) group determined a diagnostic classification for leukemias. but in spite of some reports on different clinical findings and prognosis of HMC and LGL there is no place for Hand- Mirror Cell leukemia and LGL leukemia in this classification. On the other hand, there are different ideas about causes of Hand Mirror Cell and about different changes of large granlar lymphocyte in malignancies including leukemias.Therefore, We decided to evaluate HMC & LGL in leukemic patients in Sayed Al- Shohadda Hospital in Isfahan province. This study was performed on 595 cases of leukemia during 1993-1998. We studied stained peripheral blood and bone marrow aspiration smears of the leukemic patients at the time of diagnosis, in remission and relapse phase of disease. Contrary to our anticipation, the results showed no increase in frequency of leukemia during 1993-1998, but leukemia was more frequent among males than females (2/1). LGL percent was lower than normal in the majority of patients in peripheral blood at the time of diagnosis and relapse phase. LGL percent was normal or increased in 90% of the patients in the remission phase and was lower than normal in 10% of them. Also no case of LGL leukemia was recognized. HMC percent in peripheral blood was normal in 99% of the patients at the time of diagnosis but it was more than normal (20%) only in one patient (ALL-L2) and it was normal in peripheral blood in the majority of patients in remission phase. HMC percent in peripheral blood was normal in the majority of patients in relapse phase but more than normal in one patient with ALL-L2 (15%). HMC percent in the bone marrow was normal in 98% of the patients at the time of diagnosis but it was more than normal in seven patients. Also it was also normal in the bone marrow in the majority of patients during remission and at the time of diagnosis and it has increased in three patients during the relapse phase. In conclusion, a low percent of LGL at the time of diagnosis and during the relapse phase shows a probable insufficiency in the immune system and no case of LGL leukemia was recognized. Also, four cases of Hand- Mirror Variant Leukemia with lymphoid origin (mostly ALL-L2) were recognized which should be under more investigation in the future.