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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:
Night sweats for 4 weeks. Patient had been followed with peripheral blood testing every 6 months because it was found posttransplant that the donor had acute promyelocytic leukemia with the classic t(15;17) and PML/RAR alpha fusion transcript. Testing had been negative up until this time. PET CT scan showed an active 10.5 cm mass in the kidney allograft.
Demonstration of imputability or root cause:
Biopsy showed the PML/RAR alpha rearrangement and DNA short tandem repeat analysis showed donor origin. Bone marrow was not involved.
Suggest new keywords:
Leukemia, myeloid, promyelocytic
Williams T, Aljitawi OS, Moussa R, McHugh S, Dusing R, Abraha J, et al. First case of donor transmitted non-leukemic promyelocytic sarcoma. Leukemia & lymphoma. 2012;53(12):2530-4.
Carl-Ludwig: agree to Michael. Would be interesting to know more about both kidney recipient (immunosuppression, immunolgicial match -> try to find an explanation why one recipient affected and the other not or is it not reported yet?)
Expert comments for publication:
The patient responded to specific chemotherapy but eventually lost her kidney to rejection. There were two other recipients from the same donor. A liver recipient died of sepsis one year after transplant with no evidence of tumor. The second kidney recipient was monitored for 7 years at the time of publication without evidence of tumor. The long interval between transplant and tumor in this case indicates a need for extended followup for these patients at risk. This also highlights involvement of the allograft without typical bone marrow involvement, suggesting passenger tumor cells within the graft. See also Notify record n.2043 (Alhuraiji et al) for a similar case report.