Detection of donor cell derived acute myelogenous leukaemia in a patient transplanted for chronic myelogenous leukaemia using fluorescence in situ hybridization

Abstract

The recurrence of leukaemia following allogeneic bone marrow transplantation appears to develop rarely in donor cells. However, the standard method for assigning the origin of recurrence, metaphase analysis, can be unreliable. We have applied the technique of fluorescence in situ hybridization (FISH) directly on archival Wright stained bone marrow slides obtained from a patient who developed acute myelogenous leukaemia (AML) following allogeneic bone marrow transplantation (BMT) for chronic myelogenous leukaemia (CML). Using a chromosome-specific DNA probe we linked a chromosomal aberration, previously detected by conventional metaphase analysis, directly to morphologically identifiable blast cells. In this way we were able to assess cell-lineage involvement of the secondary leukaemia and assign a donor origin.

Donor cell myelodysplastic syndrome after allogeneic stem cell transplantation responding to donor lymphocyte infusion: Case report and literature review

“…A diagnosis of refractory anemia was made. His disease progressed to acute myelogenous leukemia (AML) within two years [7]. Abeliovich described two female cases, the first with AML and the second with MDS.…”

Acute myeloid leukaemia of donor cell origin developing 5 years after allogeneic bone marrow transplantation for chronic myeloid leukaemia

“…3,5,12 Combination of FISH with morphology or immunophenotyping seems to be a further diagnostic approach to determine the donor origin of leukaemia as has happened in this case. 3,4 Cytogenetic abnormalities are known in de novo AML, MDS, secondary AML and DCL. In our patient, however, we did not find any chromosomal abnormality with traditional cytogenetic methods.…”

“…In addition, the sorted CD34 ϩ cells proved to give two X or even 4 X sig- Seventeen cases of DCL have previously been reported after BMT for leukaemia and two cases after transplant for benign disease. [2][3][4][5][6][7] The 19 cases of DCL include 11 female and eight male patients with a median age of 19.6 years (range 3-43). The time interval from BMT to diagnosis of DCL ranged from 2 to 135 months (median 33 months).…”

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

“…With molecular methods it was determined that the secondary leukemia developed in cells of donor origin. 9 In addition, a patient transplanted at Princess Margaret Hospital for CML had developed overt MM years post transplant. This occurred following the patients donor having developed the same disease (J Lipton, Princess Margaret Hospital, personal communication).…”

“…8 Donor cell-derived malignancies occurring late in recipients post bone marrow transplant have also been described. 9 At our institution, a patient with CML developed AML post transplant. With molecular methods it was determined that the secondary leukemia developed in cells of donor origin.…”