Bone marrow aspirates as part of routine donor assessment for allogeneic blood and marrow transplantation can reveal presence of occult hematological malignancies in otherwise asymptomatic individuals

Kiss, Thomas; Chang, Hong; Daly, Andrew; Messner, Hans A.; Jamal, N; Spaner, David; Rubin, Steven D.; Lipton, Jeff H.

doi:10.1038/sj.bmt.1704430

Cited by 21 publications

(13 citation statements)

References 12 publications

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“…Of course, these rates do not include secondary malignancies of donor cell origin arising in the recipient after HCT. The occurrence of three donors with hematological malignancies within 99 allogeneic HCT during 1 year (3%) in a single institution as described by Kiss et al 56 contrasts with current knowledge and warrants explanation. Overall incidence may be underestimate, since reporting of such complications might be incomplete and older donors have been used on a large scale only since 1999.…”

Section: Transmission Of Malignant Diseasesmentioning

confidence: 60%

Transmission of donor illness by stem cell transplantation: should screening be different in older donors?

Niederwieser¹,

Gentilini²,

Hegenbart³

et al. 2004

Bone Marrow Transplant

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Summary:With increasing donor age, the potential of transmitting diseases from donor to recipient reaches new dimensions. Potentially transmittable diseases from donors include infections, congenital disorders, and acquired illnesses like autoimmune diseases or malignancies of hematological or nonhematological origin. While established nonmalignant or malignant diseases might be easy to discover, earlystage hematological diseases like CML, light-chain multiple myelomas, aleukemic leukemias, occult myelodysplastic syndromes and other malignant and nonmalignant diseases might not be detectable by routine screening but only by invasive, new and/or expensive diagnostic tests. In the following article, we propose recommendations for donor work-up, taking into consideration the age of the donors. In contrast to blood transfusions, stem cells from donors with abnormal findings might still be acceptable for HCT, when no other options are available and life expectancy is limited. This issue is discussed in detail in relation to the available donor and stem cell source. Finally, the recommendations presented here aim at harmonized worldwide work-up for donors to insure high standard quality.

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Section: Transmission Of Malignant Diseasesmentioning

confidence: 60%

Transmission of donor illness by stem cell transplantation: should screening be different in older donors?

Niederwieser¹,

Gentilini²,

Hegenbart³

et al. 2004

Bone Marrow Transplant

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“…Other potential disadvantages of marrow evaluation in the screening of potential bone marrow donors include increased cost, possible morbidity, and increased reluctance of candidates to undergo the screening process. 23 For all these reasons, extensive donor screening should be undertaken carefully, and decisions about what to do with the results must be made in context of individual patient circumstances. 24 …”

Section: Discussionmentioning

confidence: 99%

Targeted Pathologic Evaluation of Bone Marrow Donors Identifies Previously Undiagnosed Marrow Abnormalities

Tilson

Jones

Sexauer

et al. 2013

Biology of Blood and Marrow Transplantation

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Potential bone marrow donors are screened to ensure the safety of both the donor and recipient. At our institution, potential donors with abnormal peripheral blood cell counts, a personal history of malignancy, or age >60 years are evaluated to ensure that they are viable candidates for donation. Evaluation of the marrow includes morphologic, flow cytometric and cytogenetic studies. 122 potential donors were screened between the years of 2001–2011, encompassing approximately 10% of all donors. The median age of the screened potential donors was 59 years, and included 59 men and 63 women. The donors were screened because of age >60 years old (33), anemia (22), cytopenias other than anemia (27), elevated peripheral blood counts without a concurrent cytopenia (20), elevated peripheral blood counts with a concurrent cytopenia (10), history of malignancy (4), abnormal peripheral blood differential (3), prior graft failure (1), history of treatment with chemotherapy (1), and body habitus (1). Marrow abnormalities were detected in 9% (11/122) of donors. These donors were screened because of anemia (5/22; 23%), age >60 years (2/33; 6%), history of malignancy (2/4; 50%), elevated peripheral blood counts (1/20; 5%), and body habitus (1/1; 100%). Abnormalities included plasma cell dyscrasia (3), abnormal marrow cellularity (3), clonal cytogenetic abnormalities (2), low-grade myelodysplastic syndrome (1), a mutated JAK2 V617F allele (1), and monoclonal B-cell lymphocytosis (1). Our experience indicates that extended screening of potential donors identifies a significant number of donors with previously undiagnosed marrow abnormalities.

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“…The second is the development of leukemia in normal donor stem cells. These leukemia transfer cases at the time of transplant indicate the need for careful evaluation of donors prior to graft collection, 27,29 particularly if they are relatives, older, or have positive family history of CLL.…”

Section: Resultsmentioning

confidence: 99%

Genetically identical twin transplantation for chronic lymphocytic leukemia

et al. 2007

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We identified 19 persons with B-cell chronic lymphocytic leukemia (CLL) who received genetically identical twin blood cell or bone marrow transplants after high-dose conditioning. Ten are alive (eight disease-free) with a median follow-up of 89 months (range, 31-171 months); 5-year relapse rate was 50% (95% confidence interval (CI), 26-73%). Estimated 5-year survival and disease-free survival were 61% (95% CI, 37-82%) and 45% (95% CI, 23-68%). In two of four patients tested at 12 and 21 months by polymerase chain reaction no evidence of residual CLL was detected post-transplant. In one recipient who relapsed at 6 years, molecular studies showed a different CLL clone from that detected pretransplant. This clone was subsequently identified in the donor suggesting transfer of occult leukemia at the time of transplant. Genetically identical twin transplants can result in long-term disease-free survival and molecular remissions, these data suggest the potential for CLL control in the absence of allogeneic graft-versus-leukemia effect. The case of leukemia transfer indicates the need for careful evaluation of donors prior to graft collection.

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Bone marrow aspirates as part of routine donor assessment for allogeneic blood and marrow transplantation can reveal presence of occult hematological malignancies in otherwise asymptomatic individuals

Cited by 21 publications

References 12 publications

Transmission of donor illness by stem cell transplantation: should screening be different in older donors?

Transmission of donor illness by stem cell transplantation: should screening be different in older donors?

Targeted Pathologic Evaluation of Bone Marrow Donors Identifies Previously Undiagnosed Marrow Abnormalities

Genetically identical twin transplantation for chronic lymphocytic leukemia

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