Acute myeloid leukaemia of donor cell origin developing 5 years after allogeneic bone marrow transplantation for chronic myeloid leukaemia

Abstract

Summary:We report the case of a male patient with Ph-positive CML who developed AML 5 years after allogeneic BMT. Clinically, the AML seemed to develop on the basis of a myelodysplasia. The myeloid origin of blasts has been proven by immunophenotyping. The variable number of tandem repeats (VNTRs) and short tandem repeat (STR) showed donor-type haemopoiesis. The interphase FISH showed the XX genotype directly in the morphologically identifiable blasts and in the CD34-positive sorted bone marrow cells. This proved the new leukaemia to be of donor origin. The necessity of using multiple techniques and the advantage of combined immunophenotyping and FISH methods in this case is emphasized.

First report of donor cell–derived acute leukemia as a complication of umbilical cord blood transplantation

“…Subsequent to that report, we identified 6 further reported cases. [2][3][4][5][6][7] Analysis of these cases does not suggest a common mechanism, and we can only speculate as to the etiology of this rare complication. Of 24 cases, 21 occurred following transplantation for leukemia, but there have been cases reported after transplantation for nonmalignant conditions.…”

“…12 Of the 24 cases of DCL previously described, 3 developed AML after antecedent MDS. 1,4,7 Our patient had received only 600 mg/m 2 of etoposide and 200 mg/kg of cyclophosphamide, much less than doses usually associated with t-MDS/ AML. The fact that the risk of t-MDS/AML is higher after autologous transplantation than after conventional chemotherapy and radiation therapy 13 suggests that the transplantation process itself may potentiate t-MDS/AML, although the mechanism remains unclear.…”

“…[1][2][3][4][5][6][7] Umbilical cord blood has emerged as an alternative source of hematopoietic stem cells over the past decade, with more than 6000 umbilical cord blood transplants (UCBTs) performed worldwide. 8 We report the first case of DCL following UCBT.…”

Acute myeloid leukemia of donor origin after allogeneic bone marrow transplantation for precursor T-cell acute lymphoblastic leukemia: Case report and review of the literature

“…In our case, no evaluation for an underlying MLL rearrangement has been performed; however, the donor is reportedly alive and well with no evidence of a past or present hematologic disorder. [23,[25][26][27][28][29][30][31], to the best of our knowledge. A summary of the cases, including pre-BMT diagnosis, post-BMT diagnosis, and the time interval to donor-derived leukemia after BMT, are presented in Table I.…”

Donor cell leukemia after umbilical cord blood transplantation: recurrent or de novo? The importance of diagnosis for therapeutic decision making

“…The incidence of DCL after SCT may be underestimated, as chimerism analysis can be difficult and the results of cytogenetic studies alone are sometimes misleading [7,8]. Numerous mechanisms for the genesis of DCL, including (1) occult leukemia or a pre-leukemic state in the donor, (2) a defect in immune surveillance, (3) transfer of oncogenic material from the host to donor cells, (4) therapy-related stromal abnormalities, and (5) excess cytokine stimulation and DNA replication and/or repair errors associated with post-transplant expansion of stem/progenitor cells, have been reported [9][10][11][12]. However, because of the rarity and heterogeneity of cases of DCL, the causal mechanisms may prove elusive.…”