Status:
Ready to upload
Record number:
2314
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
The authors note that donor cell leukemia is estimated to occur with a frequency near 0.1% of hematopoietic cell transplants.
Time to detection:
Patient 1 (male, 25yo at transplant): 23 years post transplant
Patient 2 (female, 50yo at transplant): Diagnosis made 43 months after transplant; retrospective study showed rare malignant blasts present at 21 months after transplant
Alerting signals, symptoms, evidence of occurrence:
Patients 1 and 2: Pancytopenia
Demonstration of imputability or root cause:
Patient 1: Male recipient of a female stem cell transplant. Malignant cells showed XX genotype
Patient 2: Leukemia occurred during a period of complete donor chimerism
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case Report
Single Center Series
Living donor
Cytogenetic analysis
Sex chromosomes
DNA typing
Histologic analysis
Leukemia, myeloid, promyelocytic
Allogeneic Hematopoietic stem cell transplantation
Therapy discussed
FISH (fluorescence in situ hybridization)
Reference attachment:
Suggest references:
Bouvier A, Ribourtout B, Francois S, Orvain C, Paz DL, Beucher A, et al. Donor cell-derived acute promyelocytic leukemia after allogeneic hematopoietic stem cell transplantation. Eur J Haematol. 2018;101(4):570-4.
Note:
Case uploaded 6/30/24 MN
First review 6/30/24 MN
Second review 7/20/24 KM
Expert comments for publication:
This report describes rare occurrences of donor-derived (not donor transmitted) leukemia in two patients who underwent allogeneic hematopoietic stem cell transplant as part of treatment for M2 acute myelocytic leukemia. Notably, in the case of patient 1 (onset time 23 years post-transplant), donor followup for 33 years showed no evidence of leukemia. In both cases the leukemias showed t(15;17), and remission was induced with regimens containing all-trans retinoic acid. The authors speculate on possible causes of donor cell acute leukemias, such as treatment associated microenvironmental changes, weakend immune surveillance, viruses, telomere shortening, and occult donor leukemia or preleukemia. In the last case, they draw attention to the fact that CHIP (clonal hematopoiesis of indeterminate potential) is more common in older donors, and awareness of the possibility of this complication should be maintained. They also draw attention to the long onset time in patient 1, in contrast to the typical median onset times of donor leukemias seen after cord blood (median 16.5months), bone marrow (median 36.5 months), or peripheral blood stem cell (median 36 months) transplants.