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Adverse Occurrence type:
Most recent risk assessment for leukemia (Council of Europe, 2018): donors with active leukemia are considered to represent an unacceptable risk for tumor transmission. Data at this time do not allow for discrimination of individual types of leukemias. Donors with treated leukemia after a disease-free interval of 5 to 10 years are assumed to represent a high risk for tumor transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Patient complained of fatigue at 1 year posttransplant visit. Increased creatinine was found, donor-specific antibodies were detected and kidney biopsy performed. The diagnosis of B cell leukemia was initially made on the kidney biopsy.
Demonstration of imputability or root cause:
Follow up bone marrow biopsy showed leukemic blasts and molecular genetic HLA subtyping demonstrated donor HLA type.
Suggest new keywords:
Leukemia, lymphocytic, acute lymphoblastic
Cassol CA, Hod-Dvorai R, Hubbell C, Aggarwal V, Sinha S, Gentile T, et al. Donor-derived Philadelphia chromosome-positive B cell lymphoblastic leukemia presenting with renal allograft involvement in the first year posttransplant. Am J Transplant. 2019;19(3):956-7.
MN review 4/19/20
Expert comments for publication:
Hematologic studies showed that this malignancy was positive for the t(9;22) Philadelphia chromosome translocation. Therefore, this would not be considered to be a PTLD of donor cell origin, but instead represents transmission of a donor malignancy. Interestingly, the recipient of the contralateral kidney did not develop tumor. The patient reported here received chemotherapy and stem cell transplant (detailed in report) without allograft nephrectomy and was in remission with a functioning allograft 11 months after diagnosis.