Status:
Ready to upload
Record number:
2192
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:
Initial diagnosis of tumor was made by lymph node biopsy at 6 months post bone marrow transplant in a patient with treated promyelocytic leukemia.The lymph node had been enlarging for 2 months. Due to increased EBV level it was initially misdiagnosed as PTLD. Following nonresponse to Rituximab-CHOP therapy, the diagnosis was later revised to angioimmunoblastic T cell lymphoma.
Alerting signals, symptoms, evidence of occurrence:
The donor (patient’s sister) developed lymphoma 3 months after the transplant. The recipient developed an enlarging lymph node at 4 months posttransplant and this was biopsied at 6 months.
Demonstration of imputability or root cause:
Comparison with the donor’s lymphoma showed similar histology. Both tumors demonstrated the same T cell receptor rearrangement. Short tandem repeat DNA analysis showed the tumor in the recipient to be of donor origin.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Case Report
Living donor
Bone marrow allograft transplant
Bone marrow transplant
DNA typing
Lymphoma, T cell
Leukemia, myeloid, promyelocytic
Therapy discussed
Reference attachment:
Suggest references:
Kreft A, Springer E, Geissinger E, Wagner EM, Bender K, Kolbe K, Hainz M, Rosenwald A, Herr W, Kirkpatrick CJ, Meyer RG. Transmission of angioimmunoblastic T-cell lymphoma by bone marrow transplant. Leuk Lymphoma. 2015 Apr;56(4):1164-7. doi: 10.3109/10428194.2014.949702. Epub 2014 Oct 9. PMID: 25120051.
Note:
upload MN 5/8/22
first review MN 3/22/24
second reviwe CLFF 5/20/24
Expert comments for publication:
This report highlights the rare event of lymphoma (angioimmunoblastic T cell lymphoma, AITL) transmission by bone marrow transplant despite pre-transplant donor workup. The donor developed tumor 3 months after donation, and the recipient a short time thereafter. This coincided with an increase in EBV-positive cells in the recipient, leading to the erroneous initial impression of B cell PTLD. The authors hypothesize that the EBV-stimulated B cells could have provided the microenvironment necessary for progression of the malignant T cell clone. Re-analysis of a residual donor bone marrow donation sample did not show evidence of a malignant T cell clone, indicating that the number of transferred malignant cells was quite low.
The recipient expired of AITL despite chemotherapy. No evidence of her original disease (promyelocytic leukemia) was found.
The report also highlights the importance of a thorough pathologic workup of posttransplant lymphoproliferations, even in the setting of increased EBV levels, and particularly in the setting of atypical response to therapy.