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Symptoms often remain subtle until cytopenia or infection develops. Severe infection secondary to neutropenia represents the major cause of mortality. We describe an uncommon case involving an 81\u2010year\u2010old woman diagnosed with T\u2010LGLL whose agranulocytosis was followed by recurrent infections. Immunosuppressive agents such as methotrexate, cyclophosphamide, and tacrolimus\u2014commonly recommended by current guidelines\u2014were administered but failed to improve neutropenia. Administration of fludarabine, a purine analog listed as a second\u2010line option in the NCCN guidelines, led to a prompt rise in neutrophil counts and a concomitant decline in LGL levels. To our knowledge, no prior Japanese report has documented successful use of fludarabine monotherapy for T\u2010LGLL\u2010related neutropenia, prompting us to describe this case.<\/jats:p>","DOI":"10.1155\/crh\/4086081","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T10:12:09Z","timestamp":1768903929000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful Treatment of Neutropenia Associated With T\u2010Cell Large Granular Lymphocytic Leukemia Using Fludarabine"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5196-7930","authenticated-orcid":false,"given":"Yoshiki","family":"Uemura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5939-0870","authenticated-orcid":false,"given":"Kazuto","family":"Togitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7477-6396","authenticated-orcid":false,"given":"Yoshitaka","family":"Kumon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/0049-0172(91)90002-H"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.1995.tb02271.x"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-102-2-169"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2022.07.004"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.thj.6200149"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.62347\/URFI7647"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-296962"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/2324709620941303"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.138.6.1724"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2017.1284585"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1098-3597(06)80053-0"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-01-643569"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V89.1.256"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.12871"},{"key":"e_1_2_12_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2014.298"},{"key":"e_1_2_12_16_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V84.7.2164.2164"},{"key":"e_1_2_12_17_2","doi-asserted-by":"publisher","DOI":"10.1080\/10245332.2015.1101977"},{"key":"e_1_2_12_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.05.020"},{"key":"e_1_2_12_19_2","first-page":"16","article-title":"Chronic Arthritis in the Adult, as Sociated with Splenomegaly and Leukopenia","volume":"35","author":"Felty A. 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