Donor-derived acute myeloid leukemia in a kidney transplant recipient

Abstract

volume was 77 mL/kg, twice the laboratory's top normal range in women (28 mL/kg). Serum erythropoietin level was repeated and was found to have decreased below normal at 3.0 mU/mL. A diagnosis of PV was made, and a therapeutic phlebotomy was initiated.To date, the patient has undergone 38 therapeutic phlebotomies during a 6-year period, and the patient continues with elevated hemoglobin concentrations and platelet counts. Her symptoms are well controlled, although she continues to have splenomegaly according to both physical examination and radiographic imaging results. She has never had a thrombotic event, nor has she ever received a cytotoxic agent.Result of a repeated bone marrow biopsy, performed 12 years after the initial diagnosis of PMF and 6 years after the diagnosis of PV, was a markedly hypercellular presence, without reticulum or fibrosis. Genetic study results showed a normal karyotype, and fluorescence in situ hybridization testing results did not reveal abnormalities. A quantitative JAK2 assay result showed an allele burden of 54%. At this point in the course of the disease, there is no evidence of prior MF in this patient.The case of this patient demonstrates the evolution of transfusiondependent PMF into phlebotomy-dependent PV, a reversal of the usual progression. According to the DPSS-plus risk system, the patient had 3 adverse features on presentation, placing her in the Intermediate-2 group with a median survival time of 3.6 years. Despite these adverse features on presentation, she has now survived 13 years after the intial presentation and is behaving in an indolent fashion, typical of PV and not PMF.

Donor-Derived Myeloid Sarcoma in Two Kidney Transplant Recipients from a Single Donor

“…As opposed to previous reports of leukemia after solid organ transplantation, this report demonstrates leukemic involvement of only the transplanted organs [ 4 – 6 ]. We believe that these cases may be the first reported cases of donor transmitted renal-limited myeloid sarcoma to two recipients from the same deceased organ donor.…”

“…This report describes the rare development of donor-derived myeloid sarcoma in two kidney transplant recipients from a single donor. Donor-derived leukemia has been reported after solid organ transplantation in liver transplant recipients and in a renal transplant recipient [ 4 – 6 ]. In these cases, the authors hypothesized that the most likely mechanism of disease was transformation of normal hematopoietic stem cells residing in the allograft into a malignant clone following transplantation.…”

“…In these cases, the authors hypothesized that the most likely mechanism of disease was transformation of normal hematopoietic stem cells residing in the allograft into a malignant clone following transplantation. The authors favored this hypothesis given the absence of clinically evident disease in the donor prior to donation, a greater than two-year interval between transplantation and leukemic presentation, and the lack of involvement in recipients who received other organs from the same donor [ 4 – 6 ]. In the present report, although there was no evidence of preexisting hematologic malignancy in the donor, it appears most likely that a leukemic clone was transplanted through kidney tissue as both kidney transplant recipients were affected, disease was renal-limited, and both FISH and molecular genotyping analyses confirmed that the malignant cells were of donor origin.…”

Update on umbilical cord blood transplantation

“…A small study using fucosylation of UCB cells has shown engraftment in 14 days 22 . The combination of haploidentical with either a single or double UCBT has been shown to improve engraftment 23 – 25 .…”

Multiple myeloma derived from a kidney transplant donor who also developed myeloma after kidney donation

“…In a systematic review that analyzed 104 donor‐transmitted cancers by renal graft, the most common types of transmitted cancer were renal cancer, melanoma, lymphoma, and lung cancer . In addition, there have been several reports about donor‐derived cancers (de novo cancers developing in transplanted donor cells) …”