T-cell large granular lymphocytic leukaemia: the decisions you may face

Cancer page →Second-opinion finder →

1 treatment setting, 1 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Other settings

Symptomatic or cytopenic

4 optionsCompare side by side →

Low-dose methotrexate, cyclosporin or cyclophosphamide, used sequentially; salvage with alemtuzumab, JAK inhibitors or splenectomy.

The options, in plain words

MethotrexateApprovedAntifolate (DHFR inhibitor)

The 1948 antifolate that produced the first chemotherapy remissions in childhood leukaemia and the first cure of a solid tumour; still essential in ALL, lymphoma, osteosarcoma and CNS lymphoma.

CyclophosphamideApprovedAlkylating agent (oxazaphosphorine prodrug)

Cyclophosphamide is an alkylating chemotherapy that damages DNA in dividing cells. It is part of CHOP for lymphoma, AC for breast cancer and VAC for childhood sarcomas, clears lymphocytes before CAR-T and prevents graft-versus-host disease after transplant; bladder bleeding, infertility and secondary leukaemia are its harms.

AlemtuzumabApprovedMonoclonal antibody (anti-CD52)

Alemtuzumab (Campath) is an antibody that wipes out lymphocytes carrying the CD52 marker. It is approved for chronic lymphocytic leukaemia and is supplied in the US through a restricted distribution programme.

RuxolitinibApprovedSmall-molecule JAK1/JAK2 inhibitor

Ruxolitinib was the first JAK inhibitor: it shrinks the spleen and relieves symptoms in myelofibrosis and controls blood counts in polycythaemia vera, without eliminating the disease clone.

Also referenced:Leukaemia (all types)

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Methotrexate all recorded rates →

High-dose methotrexate requires normal renal function, hydration, urine alkalinisation and leucovorin rescue with level monitoring.

Ruxolitinib all recorded rates →

Reduce dose for CrCl below 60 with platelets under 150; dialysis dosing after each session.

Questions to ask about this decision

Between Methotrexate, Cyclophosphamide, Alemtuzumab and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (symptomatic or cytopenic), which of the standard options do you recommend and why?
Why: Guideline options include: Low-dose methotrexate, cyclosporin or cyclophosphamide, used sequentially; salvage with alemtuzumab, JAK inhibitors or splenectomy.
Am I a candidate for Methotrexate, Cyclophosphamide, Alemtuzumab or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.

Living with cancer·Standard of care