Transmission of leukemic donor cells by allogeneic stem cell transplantation in a context of familial CLL: should we screen donors for MBL?

Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia

“…In view of the fact that CLL‐type MBL is detectable in 3 – 5% of healthy adults and in 13 – 18% of siblings of patients with CLL (Rawstron et al , ; Marti et al , ; Del Giudice et al , ), the question arises as to the benefit of screening potential donors, especially family donors, pre‐transplant. Information on the outcome of CLL patients whose donor had MBL is very limited and the risk of acquiring progressive CLL from the donor should be balanced against the prognosis of the potential transplant recipient, particularly if no alternative donor or other type of treatment is available (Hardy et al , ; Flandrin‐Gresta et al , ; Herishanu et al , ). There is currently no national or international consensus on the need to screen potential donors for MBL.…”

Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia in a Solid-Organ Donor

“…Three cases of transmission of LL/CLL from stem cell donors have been described (2,4,5). In all three, the diagnosis was performed late (2, 4, and 9 years after transplantation), when symptoms appeared.…”

“…The need for a more thorough screening of elderly stem cell donors is already being called for (2,4,5). In elderly solid-organ living donors, it may also be convenient to include in their evaluation more sensitive methods for the diagnosis of this occult hematologic disease.…”

Inversion 3 Cytogenetic Abnormality in an Allogeneic Hematopoietic Cell Transplant Recipient Representative of a Donor-Derived Constitutional Abnormality

“…If significant abnormalities are noted, the donor is deferred and counseled to undergo a medical evaluation under the supervision of their primary care provider. The relative rarity of these hematologic disorders makes it difficult to recommend bone marrow evaluation except in highly unusual circumstances, such as a family history of malignancy including familial chronic lymphocytic leukemia, where familial aggregation of hematologic malignancies become manifest only at an older age [25]. An alternative strategy would be to perform peripheral blood cytogenetic analysis as part of the donor screening process; however, this could potentially add to the time needed to complete donor assessment and add to the associated costs of HCT.…”