Status:
Ready to upload
Record number:
2344
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:
Kidney recipient #1: 19 months
Kidney recipient #2: Myeloid sarcoma in allograft (which is an extramedullary manifestation of NPM1-mutant AML), time of diagnosis not given; Diagnosis was revised to acute myelocytic leukemia diagnosed at 20 months in bone marrow biopsy.
Liver recipient: 11 months
Alerting signals, symptoms, evidence of occurrence:
Not given
Demonstration of imputability or root cause:
DNA studies including mutation analysis, whole exome sequencing, chimerism studies (STR, FISH).
DNA for analyses was available for the donor and all three recipients before transplantation as well as for both kidney recipients after transplant. For the liver recipient, no viable post-transplant DNA was available. Here, imputability was shown by the presence of founder mutations in the donor and the fact that all recipients developed the same malignancy.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Deceased donor
DNA typing
Allelic analysis
Whole exome sequencing
Leukemia, myeloid, acute myelogenous
Myeloid sarcoma
Kidney transplant/
Liver transplant
Therapy discussed
FISH (fluorescence in situ hybridization)
Microsatellite analysis
Reference attachment:
Suggest references:
Marchionni L, Lobo FP, Kostadinov R, Serra A, Besso FG, Deaglio S, Stratta P, Berrino M, Zanettini C, Imada EL, Omar MN, Gaidano G, Bruno B, Saglio G, Amoroso A. Donor-derived acute myeloid leukemia in solid organ transplantation. Am J Transplant. 2022 Dec;22(12):3111-3119. doi: 10.1111/ajt.17174. Epub 2022 Sep 8. PMID: 35979657; PMCID: PMC9897593.
Note:
Please clone record for MPHO type-> Organ-> Liver -- OK (EP)
Uploaded by MN 4/16/23
First review MN 6/24/24
Second review KM 7/20/24
Expert comments for publication:
This is reportedly the first documentation of proven transmission of acute myelocytic leukemia (AML) by solid organ transplantation. Rare reports of posttransplant AML in solid organ transplant exist, but those reports either did not examine donor:recipient origin or considered the cancers to be donor-derived (i.e., donor cells undergoing post-transplant malignant transformation, not transmission of fully developed cancer). Of note, there was no suspicion of cancer in the donor at time of transplant. The authors note that premalignant hematopoietic clones are present in about 10% of people over 65 and, although there is no evidence that such cells can engraft in the case of solid organ transplant (in contrast to bone marrow transplant), older donors with hematologic abnormalities should prompt consdieration of hematologic consult. Their study also documents independent clonal evolution in the recipient tumors. Although all 3 recipients received treatment, the first kidney patient died at 30 months posttransplant, the liver recipient died at 13 months posttransplant, and the second kidney recipient underwent remission but relapsed at 64 months, underwent bone marrow transplant, and died of treatment complications at 74 months.