Of course, T-LGL leukemia can present with a severe systemic illness that is rapidly progressive and resistant to treatment but with a phenotype of CD3+ and CD56+, which is separate from the usual CD3+, CD56- T-LGL leukemia [22] Aggressive T-cell LGL leukemia is supposed to arise from clonal evolution of indolent T-cell LGL leukemia but it is more like a de novo development [23, 24].The patient in our case is also the typical CD3+CD56-, with a unique phenotype variants of dual CD4-/CD8-,while it commonly accompanied with γδ+ T-cells [25]. Here, NCAM1 is linked to T-cell large granular lymphocyte leukemia.