Post-transplant acute myeloid leukemia (PT-AML)

Abstract

Acute myeloid leukemia following organ transplantation (PT-AML) is a rare event with only a few published cases in the literature. We present three patients who developed AML (FAB M1, M5, M4) after renal, double lung or liver transplantation. Molecular analysis detected a t(9;11) in one patient and documented the recipient origin of AML in a second patient. All patients were treated with chemotherapy. Immunosuppression was reduced to cyclosporin A (CsA) and prednisone in two patients and to prednisone alone in one patient. Two patients achieved a complete remission (CR), with a remission duration of 4.6 months in one patient, the other patient died from septicemia after 15.2 months in CR. One patient was refractory to chemotherapy and died from septicemia. This report together with the documented cases in the literature suggests that PT-AML (1) develops after a median interval of 5 years after transplantation with variable latency (range, Ͻ1-17 years); (2) is heterogeneous with respect to FAB classification; (3) shows chromosomal and molecular changes typical of therapy-related AML (t-AML: −7, +8, 11q23, inv16, t(15;17)); (4) standard chemotherapy is feasible after reduction of immunosuppression and produces a CR rate of 56% with a median remission duration of 4.6 months and an overall survival of 2.6 months; (5) the major complications are early death (25%), Gram-negative septicemia, progressive disease or relapse. This review provides diagnostic and therapeutic experiences and guidelines for the management of this increasing group of post-transplant patients.

Acute megakaryoblastic leukemia AML FAB-M7 in a patient 15 years after kidney transplantation

“…Post-transplant-AML seems to develop after a median interval of 5 years (range 1-17 years). It is heterogeneous with respect to FAB classification and may show chromosomal and molecular changes [4]. However, the present case shows that AML FAB-M7 may develop as treatment related without carrying multiple chromosomal aberrations.…”

“…The most common causes are viral, bacterial or opportunistic infections, transplantat rejection, side effects of new medications or malignancies [1]. It appears that AML does develop more frequently after transplantation than in the normal population [2][3][4].…”

Leucemia mieloide aguda secundaria a inmunosupresores en una paciente trasplantada de pulmón, una inusual y letal entidad

“…En pacientes con trasplante pulmonar ha sido descrita con mucho menor frecuencia y sólo someramente dentro de estudios que incluyen leucemias agudas en todos los tipos de trasplantes de órganos sólidos 5,7,8 . Cabe destacar además que en 2 revisiones publicadas sobre neoplasias secundarias en trasplante pulmonar específicamente, no se encontró ninguna leucemia mieloide aguda (LMA) 9,10 .…”

“…Cabe destacar que en esta revisión sólo se encontraron 2 casos de LMA en trasplante pulmonar. En general, se describe la aparición de LMA después del tercer año post trasplante, aunque se han descrito entre 2 meses a 17 años post trasplante 8 . Esto podría diferenciar esta patología de los linfoma no Hodgkin relacionados a terapia, cuya incidencia es mayor en el primer año post trasplante, lo que sugiere diferentes mecanismos en su fisiopatología.…”

“…Nuestra paciente falleció a los pocos días del diagnóstico por falla ventilatoria secundaria a neumonía intrahospitalaria, sin haber recibido tratamiento para la LMA. Esto concuerda con los estudios que muestran a las infecciones y la leucemia refractaria como las causas más frecuentes de muerte 7,8,17 .…”