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Williams L, Doucette K, Karp JE, Lai C. Genetics of donor cell leukemia in acute myelogenous leukemia and myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:1535-1549. [PMID: 33686252 DOI: 10.1038/s41409-021-01214-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an important therapeutic modality for patients with acute myelogenous leukemia (AML) with poor risk features. Nonetheless, roughly 30% of such patients have leukemia recurrence and up to 2% of these are donor-derived leukemias, in which malignancy develops in the donor's transplanted cells, despite extremely low rates of leukemia in the donors themselves. Notably, over 20% of these malignancies carry chromosome 7 abnormalities nearly all of which are monosomies. Recent advances in whole exome and genome sequencing have allowed for detection of candidate genes that likely contribute to the development of AML in donor cells (donor leukemia, DCL). These genes include CEBPA, GATA2, JAK2, RUNX1, DDX41, EZH2, IDH1/2, DNMT3A, ASXL1, XPD, XRCC3, and CHEK1. The potential roles of variants in these genes are evaluated based on familial clustering of MDS/AML and corresponding animal studies demonstrating their leukemogenic nature. This review describes the spectrum of genetic aberrations detected in DCL cases in the literature with regard to the character of the individual cases, existing family cohorts that carry individual genes, and functional studies that support etiologic roles in AML development. DCL presents a unique opportunity to examine genetic variants in the donors and recipients with regards to progression to malignancy.
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Affiliation(s)
- Lacey Williams
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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2
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Baraban EG, Hu S, Hui P, Podoltsev N, Cooper D, Xu ML. Tissue-based chimerism analysis enhances detection of donor-derived neoplasia in allogeneic stem cell transplant patients. Bone Marrow Transplant 2016; 52:634-637. [PMID: 27991892 DOI: 10.1038/bmt.2016.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- E G Baraban
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - S Hu
- Division of Pathology/Laboratory Medicine, Department of Hematopathology, University of Texas MD Anderson Cancer Center, Austin, TX, USA
| | - P Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - N Podoltsev
- Department of Internal Medicine, Division of Hematology, Yale Cancer Center, Smilow Cancer Hospital at the Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - D Cooper
- Blood and Marrow Transplant Program, Robert Wood Johnson University, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - M L Xu
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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3
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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? Bone Marrow Transplant 2014; 49:1237-8. [PMID: 24887386 DOI: 10.1038/bmt.2014.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Donor cell-derived leukemia after cord blood transplantation and a review of the literature: differences between cord blood and BM as the transplant source. Bone Marrow Transplant 2013; 49:102-9. [PMID: 24013690 DOI: 10.1038/bmt.2013.127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 07/07/2013] [Accepted: 07/10/2013] [Indexed: 12/27/2022]
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.
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Tabriz N, Tannapfel A, Griesinger F, Weyhe D. Chloroma of pancreas-initial manifestation of a secondary leukemia after stem cell transplantation case report and review of the literature. J Gastrointest Surg 2013; 17:1331-5. [PMID: 23417741 DOI: 10.1007/s11605-013-2166-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/04/2013] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Chloroma is an extramedullary solid tumor consisting of immature myeloid cells. CASE PRESENTATION We report a patient with painless jaundice 6 years after allogeneic peripheral stem cell transplantation because of an acute myeloid leukemia leading us to the diagnosis of a chloroma of the pancreas as the first manifestation of a secondary host leukemia. DISCUSSION A histological examination of unclear pancreatic tumors should be mandatory in patients with a history of leukemia. If surgical therapy is unavoidable because of stenosis symptoms or for histological proof, a resection should be avoided. CONCLUSION Bypass surgery can ease the symptoms and it allows timely curative chemotherapy or stem cell transplantation.
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Affiliation(s)
- Navid Tabriz
- Department of Visceral Surgery, Pius-Hospital Oldenburg, Georgstrasse 12, 26121, Oldenburg, Germany.
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Shah NN, Bacher U, Fry T, Calvo KR, Stetler-Stevenson M, Arthur DC, Kurlander R, Baird K, Wise B, Giralt S, Bishop M, Hardy NM, Wayne AS. Myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation: diagnostic and therapeutic challenges. Am J Hematol 2012; 87:916-22. [PMID: 22473867 PMCID: PMC3454494 DOI: 10.1002/ajh.23174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Nirali N Shah
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Donor-derived isolated del(20q) after hematopoietic stem cell transplantation: report of two cases and review of the literature. J Hematop 2011. [DOI: 10.1007/s12308-011-0123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Wang E, Hutchinson CB, Huang Q, Lu CM, Crow J, Wang FF, Sebastian S, Rehder C, Lagoo A, Horwitz M, Rizzieri D, Yu J, Goodman B, Datto M, Buckley P. Donor cell-derived leukemias/myelodysplastic neoplasms in allogeneic hematopoietic stem cell transplant recipients: a clinicopathologic study of 10 cases and a comprehensive review of the literature. Am J Clin Pathol 2011; 135:525-40. [PMID: 21411775 DOI: 10.1309/ajcppjuq9dnr1ghp] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report 10 cases of donor cell leukemia (DCL). All cases except the case of chronic lymphocytic leukemia had anemia, neutropenia, and/or thrombocytopenia when DCL was diagnosed. Eight cases with sex-mismatched hematopoietic stem cell transplant (HCT) showed donor gonosomal complements, suggesting DCL. Clonal cytogenetic abnormalities were detected in 8 cases: 6 were monosomy 7/del(7q). In all 10 cases, engraftment studies confirmed donor cell origin. Retrospective fluorescence in situ hybridization in archived donor cells in 4 cases showed a low level of abnormalities in 2. Of 7 patients with clinical follow-up of 5 months or more, 1 (with acute myeloid leukemia) died of disease; 6 are alive, including 1 with myelodysplastic syndrome with spontaneous remission. Similar to reported cases, we found disproportional sex-mismatched HCTs, suggesting probable underdetection of DCL in sex-matched HCTs. The latency between HCT and DCL ranged from 1 to 193 months (median, 24 months), in keeping with the literature. Analyzing our cases, pooled with reported cases, with survival models showed much shorter latency for malignancy as primary disease, for T-cell large granular lymphocyte leukemia as type of DCL, and for umbilical cord blood as stem cell source.
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Wiseman DH. Donor cell leukemia: a review. Biol Blood Marrow Transplant 2010; 17:771-89. [PMID: 20951819 DOI: 10.1016/j.bbmt.2010.10.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
Abstract
Relapse of acute leukemia following hematopoietic stem cell transplantation (HSCT) usually represents return of an original disease clone, having evaded eradication by pretransplant chemo-/radiotherapy, conditioning, or posttransplant graft-versus-leukemia (GVL) effect. Rarely, acute leukemia can develop de novo in engrafted cells of donor origin. Donor cell leukemia (DCL) was first recognized in 1971, but for many years, the paucity of reported cases suggested it to be a rare phenomenon. However, in recent years, an upsurge in reported cases (in parallel with advances in molecular chimerism monitoring) suggest that it may be significantly more common than previously appreciated; emerging evidence suggests that DCL might represent up to 5% of all posttransplant leukemia "relapses." Recognition of DCL is important for several reasons. Donor-derivation of the leukemic clone has implications when selecting appropriate therapy, because seeking to enhance an allogeneic GVL effect would intuitively not have the same role as in standard recipient-derived relapses. There are also broader implications for donor selection and workup, particularly given the growing popularity of nonmyeloblative HSCT and corresponding rising age of the potential donor pool. Identification of DCL raises potential concerns over future health of the donor, posing ethical dilemmas regarding responsibilities toward donor notification (particularly in the context of cord blood transplantation). The entity of DCL is also of research interest, because it might provide a unique human model for studying the mechanisms of leukemogenesis in vivo. This review presents and collates all reported cases of DCL, and discusses the various strategies, controversies, and pitfalls when investigating origin of posttransplant relapse. Putative etiologic factors and mechanisms are proposed, and attempts made to address the difficult ethical questions posed by discovery of donor-derived malignancy within a HSCT recipient.
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Affiliation(s)
- Daniel H Wiseman
- Haematology Department, Manchester Royal Infirmary, Manchester, United Kingdom.
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Jeong SH, Han JH, Jeong SY, Kang SY, Lee HW, Choi JH, Park JS. A case of donor-derived granulocytic sarcoma after allogeneic hematopoietic stem cell transplantation. THE KOREAN JOURNAL OF HEMATOLOGY 2010; 45:70-2. [PMID: 21120167 PMCID: PMC2982999 DOI: 10.5045/kjh.2010.45.1.70] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/09/2010] [Accepted: 03/09/2010] [Indexed: 01/22/2023]
Abstract
The occurrence of granulocytic sarcoma as a pattern of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare. In this paper, we report a rare case of acute myeloid leukemia (AML) relapsed as a granulocytic sarcoma of the donor type. The patient was diagnosed as having AML and underwent an allo-HSCT from his matched sibling donor. Fifty-seven months after allo-HSCT, he developed granulocytic sarcomas of duodenum, jejunum, and left sterno-cleido-mastoid muscle. The bone marrow was normal with 100% donor chimerism. A Y chromosome PCR was performed on the patient's duodenum specimen as well as bone marrow aspirate in order to check the patient-origin cells. The duodenal specimen was found to contain 41.2% SRY-positive cells (from the donor). Repeat endoscopy on day 2 of chemotherapy showed that the granulocytic sarcoma had shrunk dramatically. The patient died of sepsis during the nadir state 35 days after starting salvage chemotherapy.
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Affiliation(s)
- Seong Hyun Jeong
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
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Risks and Mechanisms of Oncological Disease Following Stem Cell Transplantation. Stem Cell Rev Rep 2010; 6:411-24. [DOI: 10.1007/s12015-010-9134-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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12
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Cetin Z, Tezcan G, Karauzum SB, Kupesiz A, Manguoglu AE, Yesilipek A, Luleci G, Hazar V. Donor cell-derived acute myeloblastic leukemia after allogeneic peripheral blood hematopoietic stem cell transplantation for juvenile myelomonocytic leukemia. J Pediatr Hematol Oncol 2006; 28:763-7. [PMID: 17114967 DOI: 10.1097/01.mph.0000243660.48808.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite its rarity, donor cell leukemia (DCL) is a most intriguing entity. We report here the case of a 5 year-old girl with juvenile myelomonocytic leukemia and normal female karyotype who developed acute myeloblastic leukemia with a karyotype of 46, X, t(X; 7) (p21; p11.2), der(7) t(3; 7) (q13.3; q22) 5 months after peripheral blood hematopoietic stem cell transplantation from her HLA-matched sister. We performed the analysis of short tandem repeat sequence markers to DNA obtained from donor peripheral blood, patient's peripheral blood including leukemic blasts and patient's hair root. This analysis showed that the leukemic blood DNA matched the donor blood DNA and not the patient's DNA, thus confirming DCL. To our knowledge, this is the first case of DCL after peripheral blood SCT for juvenile myelomonocytic leukemia.
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MESH Headings
- Blood Donors
- Child, Preschool
- Chromosome Aberrations
- Fatal Outcome
- Female
- Humans
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/genetics
- Leukemia, Myelomonocytic, Chronic/therapy
- Neoplasms, Second Primary
- Peripheral Blood Stem Cell Transplantation/adverse effects
- Transplantation Chimera/genetics
- Transplantation, Homologous
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Affiliation(s)
- Zafer Cetin
- Department of Pediatrics, Akdeniz University, Antalya, Turkey
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Sevilla J, Querol S, Molines A, González-Vicent M, Balas A, Carrió A, Estella J, Angel Díaz M, Madero L. Transient donor cell-derived myelodysplastic syndrome with monosomy 7 after unrelated cord blood transplantation. Eur J Haematol 2006; 77:259-63. [PMID: 16923113 DOI: 10.1111/j.1600-0609.2006.00716.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Donor cell leukaemia or myelodysplastic syndromes are extremely rare complications that have been observed not only after haematopoietic transplantation with progenitor cells harvested from bone marrow and peripheral blood, but also after cord blood transplantation. We describe the early onset of monosomy 7 in donor cells after cord blood transplantation in a patient diagnosed with myelodysplastic syndrome 3 months after transplantation. Fluorescent in situ hybridisation analysis performed in a cryopreserved aliquot of the cord blood showed 2.5% of nuclei with monosomy 7. The cord blood donor was studied and he showed neither peripheral blood cytopenias nor cytological or cytogenetic features of myelodysplasia. The cell blood counts (CBC) of the girl have improved over 2 yr while decreasing the percentage of monosomic cells. The monosomic clone has finally disappeared and the CBC are finally normal. This case of transient monosomy 7 started very early after engraftment emphasises the relevance of clonal instability of specific progenitor cells in the early engraftment, and host immune status, in cytogenetic abnormalities founded in donor cell-derived MDS and acute leukaemia. Moreover, the clinical follow-up of this patient, recommends a more conservative treatment for this clonal disease early developed after transplantation.
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Affiliation(s)
- Julián Sevilla
- Oncohematología pediátrica Hospital Universitario Niño Jesús, Madrid, Spain.
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Ataergin S, Arpaci F, Cetin T, Guran S, Yakicier C, Beyzadeoglu M, Ozet A. Donor cell leukemia in a patient developing 11 months after an allogeneic bone marrow transplantation for chronic myeloid leukemia. Am J Hematol 2006; 81:370-3. [PMID: 16628734 DOI: 10.1002/ajh.20615] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 38-year-old female with chronic myeloid leukemia underwent an allogeneic bone marrow transplantation from her full-matched brother. Eleven months later, she readmitted with an acute leukemia that was shown to be of donor origin. The patient never achieved a remission even after chemotherapies with cytarabine and mitoxantrone, donor lymphocyte infusion, and second allogeneic peripheral blood stem cell transplantation. Donor cell leukemia (DCL) is sometimes misdiagnosed as relapse by clinicians and the real incidence may be higher than expected. Cytogenetic and molecular techniques may be helpful to clarify the issue of the leukemia. The current case is another case of DCL reported in the literature after an allogeneic transplant for a kind of leukemia.
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MESH Headings
- Adult
- Bone Marrow Transplantation/adverse effects
- Chromosomes, Human, Y
- Fatal Outcome
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Male
- Philadelphia Chromosome
- Tissue Donors
- Transplantation Chimera/genetics
- Transplantation, Homologous
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Affiliation(s)
- Selmin Ataergin
- Department of Medical Oncology and Bone Marrow Transplantation Unit, Gulhane Faculty of Medicine, Ankara, Turkey
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Kraut L, Trebeljahr G, Thiele B, Fauser AA. Donor cell-derived myelodysplastic syndrome in a patient 7 years after unrelated allogeneic HLA-mismatched transplantation for Ph+ chronic myeloid leukemia. Bone Marrow Transplant 2005; 36:737. [PMID: 16086042 DOI: 10.1038/sj.bmt.1705125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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