Status:
Ready to upload
Record number:
2045
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:
6 years
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.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Deceased donor
Case report
Kidney transplant
FISH
DNA typing
Leukemia, myeloid, promyelocytic
Myelocytic sarcoma
Reference attachment:
Suggest references:
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.
Note:
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.