Donor cell leukemia: Report of a case occurring 11 years after allogeneic bone marrow transplantation and review of the literature

Abstract

We report the case of a man with chronic myelocytic leukemia (CML) and a 46,XY,t(5;9;22) karyotype who developed acute myelocytic leukemia (AML) with a 45,X,t(8;21) karyotype 11 years after bone marrow transplantation (BMT) from his HLA-matched sister. Fluorescent in situ hybridization (FISH) studies and molecular analysis using short tandem repeat (STR) sequences proved the new leukemia to be of donor cell origin. Donor cell leukemia (DCL) after BMT is rare. Our review of the literature found 15 cases following BMT for leukemia and 2 cases after BMT for benign hematological disorders. In fewer than half the reported cases were molecular studies available to confirm the cytogenetic evidence for DCL, and the longest previously reported interval between BMT and DCL was 6 years.

Donor cell derived acute myeloid leukemia after allogeneic cord blood transplantation in a patient with adult T-cell lymphoma

“…To our knowledge, although 25 cases of DCL occurring after BMT have previously been reported [4][5][6][7][8][9][10][11], there have been no reports of DCL occurring after either PBSCT or CBT.…”

“…Because the cord blood from the second donor in our case did not contain any AML blasts, this mechanism is unlikely to explain the DCL in our patient. In addition to this mechanism, Cooley et al [6] proposed the following three mechanisms for the development of DCL after BMT: (i) the conditioning regimen for BMT, especially total body irradiation (TBI), may damage the recipient tumor cells and cause the release of viral or nonviral oncogenic materials, which are then transferred to donor cells; (ii) the residual host cells undergo fusion with donor cells, and the oncogenic materials in the host cells are transferred to donor cells; (iii) immunosuppressive agents such as steroids and cyclosporine used after BMT impair immune surveillance and allow the development of DCL.…”

“…Furthermore, there have been reports of donor cell leukemia (DCL) in relapsed patients, raising a new type of ethical issue of BMT and also providing new insights into the mechanisms of leukemogenesis [4][5][6][7][8][9][10][11]. We report here a patient who developed DCL not after BMT but after CBT.…”

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

“…Fewer than 20 cases have been reported to date [4]. It is estimated that less than 5% of relapses after allogeneic SCT are of donor cell origin [5].…”

“…In most reported cases, the original disease recurred in the donor cells. Most cases were sex-mismatched, sibling transplants [4]. We found five reports of donor cell MDS after allogeneic SCT in our review of the literature.…”