Case report: Chronic Myeloid Leukemia (CML) after stem cell transplant (2003)

Most recent risk assessment for myeloproliferative disorders (includes chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, primary myelofibrosis) (Council of Europe, 2022): Due to the current lack of literature on myeloproliferative neoplasms and organ donation, the transmission risk cannot be assessed. Organs from these patients should only be accepted with the highest caution and only after consultation with an experienced haemato-oncologist. Results of the bone-marrow biopsy should be carefully evaluated. A patient admitted with unspecific but suspect symptoms like extensive thrombo-/erythro-/leukocytosis should be tested for specific oncogenes in blood and bone marrow (CD34+ cells, BCR-ABL, JAK-2, V617F-mutation, MPL-mutation, Calreticulin-mutation) to distinguish an MPN from a simply reactive situation. Since this will take 2-3 working days, it might not be suitable in the context of organ donation. Myeloproliferative neoplasms in the donor history: Due to the systemic and chronic character of these diseases and the lack of evidence on their behaviour in the setting of organ transplantation (and in the immuno-suppressed recipient), their transmission risk cannot currently be assessed. Organs from these patients should only be accepted with the highest caution. The following laboratory tests might be obtained to assess the actual situation of the pre-diagnosed MPN: complete and differential blood count, liver enzymes including LDH. Bone marrow biopsy can help to rule out blasts at the time of donation. Patients with spleno-/hepatomegaly need particular attention. An experienced haematologist should always be asked for an assessment. It might be reasonable to accept an organ donor with a pre-diagnosed MPN for selected recipients, especially in cases of confirmed MPN without need for treatment or in cases where the diagnosis has been confirmed years ago and good therapy results were obtained. PMF seems to be riskier due to a higher proportion of circulating blasts and might bear an even higher risk for transmission. 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.