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The association between large granular lymphocytic leukemia (LGLL) and neutropenia is poorly understood. We attempted to assess whether neutropenia in LGLL with paraproteinemia has a different etiology than LGLL without paraproteinemia. We found neither direct serum inhibition of granulocyte/monocyte-colony forming units in vitro nor increased immunoglobulin binding to granulocytic neutrophils, neutrophil precursors, or granulocyte/monocyte-colony stimulating factor. Clonogenic assay experiments suggested that suppression of the patient's granulocyte/monocyte-colony forming units by the neoplastic T-cells and decreased granulocyte/monocyte-colony stimulating factor production contributed to the pathogenesis of neutropenia in this particular case.
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