Donor cell-derived leukemia after cord blood transplantation and a review of the literature: differences between cord blood and BM as the transplant source

Abstract

Donor cell-derived leukemia (DCL) is a rare complication of SCT. Here, we present a case of DCL following cord blood transplantation (CBT) and review the clinical features of previously reported DCL. To our knowledge, this is the first report comparing clinical characteristics of DCL from the standpoint of the transplant source, with umbilical cord blood and BM. AML and myelodysplastic syndrome (MDS) were recognized more frequently in DCL after CBT, whereas the incidence of AML and ALL was similar after BMT. The median duration between the occurrence of DCL following CBT and BMT was 14.5 and 36 months, respectively. DCL occurred in a significantly shorter period after CBT than after BMT. Abnormal karyotypes involving chromosome 7 were observed in 52.4% of CBT recipients and 17.3% of BMT recipients; this was a statistically significant difference. Particularly, the frequency of monosomy 7 was significantly higher in DCL after CBT than after BMT. The types of abnormal karyotypes in DCL following BMT were similar to those characteristically observed in adult de novo AML and MDS. DCL patients generally have a poor prognosis in both groups. SCT is the best treatment for curing DCL. DCL appears to have different clinical features according to the transplant source.

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

“…Donor-derived hematologic malignancies have particularly been reported following umbilical cord blood (UCB) transplants, 37,96–101 with support for the likely importance of the post-HCT milieu in promoting neoplasm development. Despite a rate of up to 6% donor-derived MDS/AML in the recipient, there have been no instances of leukemia in the UCB donor.…”

Occurrence of Donor Cell-derived Lymphoid Blast Crisis 24 Years Following Related Bone Marrow Transplantation for Chronic Myeloid Leukemia

“…Reported cases with DCL, mainly acute myeloid leukemia after umbilical cord blood transplantation, are increasing according to the recent advance of diagnostic procedures such as short tandem repeat (STR) testing (4)(5)(6)(7). Although multiple mechanisms for developing DCL have been proposed, considering the diversified phenotypes of DCL with varied latency periods in previously reported cases, the pathogenesis of DCL could involve more than a single pathway (1,3,7).…”

An unusual case of B-ALL occurring in a patient with acute promyelocytic leukemia in remission after two hematopoietic SCTs: whose are the leukemic cells?

“…Of note, the median duration between BMT and the occurrence of DCL has been reported to be 36 months (range 2-312 months). 1 In conclusion, DCL may be under-diagnosed and frequently unexpected in patients suspected of having leukemia relapse after HSCT. Accurate molecular examinations, especially of chimerism by microsatellites, are essential to investigate the donor origin of leukemic cells, mainly in the cases in which a leukemic cell lineage, different from initial diagnosis, is found or when more than one HSCT has been performed.…”

“…The occurrence of leukemia or myelodysplasia from donor cells is recognized as a rare, but probably underestimated complication, especially those with a lymphoid phenotype. [1][2][3] Since the first description of this usually aggressive disorder in 1971, several other cases have been reported, 4 with a variable incidence ranging from 0.13 to 5% in HSCT recipients. 1 To the best of our knowledge, we have reported the first case of DCL with lymphoid phenotype in a patient with a previous APL diagnosis, who has needed two HSCTs from different male sibling donors, and from different stem cells sources, namely PB and BM.…”

“…[1][2][3] Since the first description of this usually aggressive disorder in 1971, several other cases have been reported, 4 with a variable incidence ranging from 0.13 to 5% in HSCT recipients. 1 To the best of our knowledge, we have reported the first case of DCL with lymphoid phenotype in a patient with a previous APL diagnosis, who has needed two HSCTs from different male sibling donors, and from different stem cells sources, namely PB and BM. Three DCL cases arising after two HSCTs, in patients with either aplastic anemia or Fanconi anemia, have previously been reported in the literature [5][6][7] (Table 1).…”