{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T11:13:50Z","timestamp":1773746030007,"version":"3.50.1"},"reference-count":65,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>T-cell non-Hodgkin lymphomas, which arise from post-thymic mature T cells, constitute approximately 10\u201315% of all non-Hodgkin lymphomas. Their leukemic presentations, referred to here as mature T-cell leukemias, are relatively uncommon and present significant diagnostic and therapeutic challenges requiring an informed approach to diagnosis and management. The initial presentation is often persistent T-cell lymphocytosis that must be distinguished from reactive (non-malignant) causes. Unlike B-cell lymphocytosis, where clonality usually indicates malignancy, T-cell clonality can be detected in benign conditions such as autoimmune disorders and viral infections. Thus, establishing clonality is helpful but not sufficient, and a systematic diagnostic approach integrating clinical features, morphology, immunophenotype, and molecular findings is critical. This review outlines our approach to the diagnosis and treatment of four major subtypes of mature T-cell leukemias: T-cell prolymphocytic leukemia (T-PLL), adult T-cell leukemia\/lymphoma (ATLL), T-large granular lymphocytic leukemia (T-LGL), and S\u00e9zary syndrome (SS). Each section includes a discussion of clinical features, workup, and treatment options.<\/jats:p>","DOI":"10.3390\/cancers18060965","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T10:21:41Z","timestamp":1773742901000},"page":"965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How We Evaluate and Treat Leukemic Presentations of Mature T-Cell Lymphomas"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8366-4838","authenticated-orcid":false,"given":"Arjun","family":"Ravishankar","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinisha","family":"Somaya","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haris","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6241-0545","authenticated-orcid":false,"given":"Ahmad","family":"Kiwan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"Montanari","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1887-9343","authenticated-orcid":false,"given":"Michael","family":"Girardi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francine","family":"Foss","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1346-2103","authenticated-orcid":false,"given":"Tarsheen","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1182\/blood-2004-01-0002","article-title":"A systematic approach to diagnosis of mature T-cell leukemias reveals heterogeneity among WHO categories","volume":"104","author":"Herling","year":"2004","journal-title":"Blood"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"El-Sharkawi, D., Attygalle, A., and Dearden, C. 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