Status:
Ready to upload
Record number:
2335
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for leukemia, lymphoma and plasmacytoma (Council of Europe, 2022):
Leukaemia, lymphoma and plasmacytoma diagnosed during donor procurement: These cancers are classified as an unacceptable risk for organ donation.
Leukaemia, lymphoma and plasmacytoma in the donor history: Active (acute or chronic) leukaemia, lymphoma and plasmacytoma are an unacceptable risk for organ donation. Treated acute leukaemia and lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission.
Time to detection:
5 months
Alerting signals, symptoms, evidence of occurrence:
Donor (father) had elevated LDH at time of transplant; 6 weeks later he had increased symptoms leading to diagnosis of adverse risk acute myeloid leukemia (AML).
Recipient (daughter) developed severe lumbar spine pain, left facial nerve palsy with ipsilateral hearing loss at 5 months posttransplant.
Demonstration of imputability or root cause:
Fluorescent in situ hybridization for XY chromosomes, genomic copy number variation analysis.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case Report
Living donor
Kidney transplant
FISH (fluorescence in situ hybridization)
Sex chromosomes
XY chromosomes
DNA typing
Allelic analysis
Leukemia, myeloid, acute myelogenous (includes myeloid sarcoma)
Therapy discussed
Reference attachment:
Suggest references:
Ghandili S, Kluger MA, Leitner T, Grahammer F, Kirchner L, Modemann F, et al. Donor-transmitted extramedullary acute myeloid leukaemia after living donor kidney transplantation. Br J Haematol. 2022;198(1):199-202.
Expert comments for publication:
The recipient developed widespread involvement, including allograft involvement, without evidence of bone marrow involvement (myeloid sarcoma) despite the presence of marrow involvement in the donor. The authors hypothesize that leukemic stem cells arose from a niche within the allograft tissue in the recipient. Therapy is discussed: allograft nephrectomy was declined and chemotherapy with adjustment of immunosuppression, followed by allogeneic stem cell transplant, was given. Unfortunately, both the patient and the donor rapidly succumbed due to disease reccurence after initial response. The authors note the rarity and poor prognosis of this condition, along with the difficulty in detecting it in cases in which it may be subclinical at the time of transplant.