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Zamani F, Karimi H, Mansoorian M, Basi A, Hosseini SA, Zahed Z, Seyedghasemipour N, Sahraie R. Early occurrence of acute myelomonocytic leukemia (M4/M5) after liver transplantation: a case report. J Med Case Rep 2023; 17:398. [PMID: 37667403 PMCID: PMC10478306 DOI: 10.1186/s13256-023-04126-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Acute myeloid leukemia is a rare event in post-liver-transplantation recipients. In the present report, we described a case of extramedullary acute myeloid leukemia, M4/M5 subtype, following orthotopic liver transplant. CASE PRESENTATION The patient was a 50-year-old Iranian woman who underwent orthotopic liver transplant due to hepatitis B-related cirrhosis (Child C, MELD (model for end-stage liver disease score) = 22). Orthotopic liver transplant was performed using the piggy back technique in January 2022. Induction immunosuppressive therapy was 1 gm methylprednisolone for 3 days followed by a triple maintenance immunosuppressive regimen including mycophenolate mofetil, prednisolone, and tacrolimus. About 5 months after orthotopic liver transplant in June 2022, the patient presented with leukocytosis, with white blood cell count of 99.4 × 103/µl, and physical examination revealed only cervical lymphadenopathy. Biopsy of cervical lymph nodes showed a myeloid tumor. She was immediately hospitalized. Eight hours after hospitalization, the patient gradually developed lethargy and decreased O2 saturation to approximately 89%. Flow cytometry demonstrated the markers of a myelomonocytic acute myeloid leukemia (M4/M5). Cytoreduction was immediately started by intensive leukopheresis followed by induction therapy. Because of a septic complication during the induction therapy, further chemotherapy was discontinued and broad-spectrum antibiotics and antifungal treatments started. Unfortunately, our patient died of severe septic shock 42 days after hospitalization. CONCLUSION Acute myeloid leukemia is a rare phenomenon after liver transplantation, and it can follow a rapidly fatal clinical course.
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Affiliation(s)
- Farhad Zamani
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsenreza Mansoorian
- Department of Surgery, Transplant Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Basi
- Department of Hematology Oncology, Iran University of Medical Sciences, Tehran, Iran
| | - S Ahmad Hosseini
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Zahed
- Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Roghayeh Sahraie
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Ghandili S, Kluger MA, Leitner T, Grahammer F, Kirchner L, Modemann F, Achilles E, Kreipe HH, Klein J, Steinemann D, Wolschke C, Fischer L, Bokemeyer C, Fiedler W, Huber TB, Alsdorf WH, Mahmud M. Donor‐transmitted extramedullary acute myeloid leukaemia after living donor kidney transplantation. Br J Haematol 2022; 198:199-202. [PMID: 35428972 PMCID: PMC9321064 DOI: 10.1111/bjh.18194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Susanne Ghandili
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Malte A. Kluger
- III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Theo Leitner
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Florian Grahammer
- III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lennart Kirchner
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Franziska Modemann
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
- Mildred Scheel Cancer Career Center, University Cancer Center Hamburg University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Eike‐Gert Achilles
- Department of Visceral Transplantation University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Hans H. Kreipe
- Institute of Pathology, Bone Marrow Reference Center Hannover Medical School Hanover Germany
| | - Janin Klein
- Institute of Human Genetics Hannover Medical School Hanover Germany
| | - Doris Steinemann
- Institute of Human Genetics Hannover Medical School Hanover Germany
| | - Christine Wolschke
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Lutz Fischer
- Department of Visceral Transplantation University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Walter Fiedler
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Tobias B. Huber
- III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Winfried H. Alsdorf
- Department of Oncology, Hematology, Bone Marrow Transplantation with Section Pneumology University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Maida Mahmud
- III. Department of Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
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Lessons Learned from Donor Cell-Derived Myeloid Neoplasms: Report of Three Cases and Review of the Literature. Life (Basel) 2022; 12:life12040559. [PMID: 35455050 PMCID: PMC9028156 DOI: 10.3390/life12040559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
Donor-cell derived myeloid neoplasm (DDMN), a rare complication after allogeneic hematopoietic cell transplantation (HCT), is of interest for its potential to reveal donor-derived and host-derived factors that contribute to the pathogenesis of leukemia. The accurate diagnosis of donor-derived leukemias has been facilitated by the more frequent use of molecular techniques. In this study, we describe three additional cases of DDMN; the first reported case of donor-derived chronic myelomonocytic leukemia (CMML), one acute myeloid leukemia (AML) with t(8;21)(q22;22); RUNX1-RUNX1T1 and one donor-derived MDS with deletion 5q. A review of the cytogenetic profiles of previously reported DDMN indicates a significant contribution of therapy-related myeloid neoplasms. Cases with direct evidence of donor- or recipient-dependent factors are rare; a role of direct transfer of leukemic cells, genomic instability of the donor, abnormal gene methylation in donor cells, proleukemic potential of abnormal stromal niche, and the role of immunological surveillance after transplantation has been observed. The role of additional potential pathogenetic factors that are without clinically observed evidence are also reviewed.
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Burns SS, Kapur R. Clonal Hematopoiesis of Indeterminate Potential as a Novel Risk Factor for Donor-Derived Leukemia. Stem Cell Reports 2021; 15:279-291. [PMID: 32783925 PMCID: PMC7419737 DOI: 10.1016/j.stemcr.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a critical treatment modality for many hematological and non-hematological diseases that is being extended to treat older individuals. However, recent studies show that clonal hematopoiesis of indeterminate potential (CHIP), a common, asymptomatic condition characterized by the expansion of age-acquired somatic mutations in blood cell lineages, may be a risk factor for the development of donor-derived leukemia (DDL), unexplained cytopenias, and chronic graft-versus-host disease. CHIP may contribute to the pathogenesis of these significant transplant complications via various cell-autonomous and non-cell-autonomous mechanisms, and the clinical presentation of DDL may be broader than anticipated. A more comprehensive understanding of the contributions of CHIP to DDL may have important implications for the screening of donors and will improve the safety of HSCT. The objective of this review is to discuss studies linking DDL and CHIP and to explore potential mechanisms by which CHIP may contribute to DDL.
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Affiliation(s)
- Sarah S Burns
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Reuben Kapur
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Molecular Biology and Biochemistry, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Wong RL, Ketcham M, Irwin T, Akilesh S, Zhang TY, Reyes JD, Edlefsen K, Jalikis F, Becker PS. Donor-derived acute promyelocytic leukemia presenting as myeloid sarcoma in a transplanted kidney. Leukemia 2020; 34:2776-2779. [PMID: 32523036 PMCID: PMC7515823 DOI: 10.1038/s41375-020-0903-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Risa L Wong
- Division of Hematology, Department of Medicine, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Megan Ketcham
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Trent Irwin
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Shreeram Akilesh
- Department of Pathology, University of Washington, Seattle, WA, USA
| | - Tian Yi Zhang
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jorge D Reyes
- Department of Surgery, Division of Transplant Surgery, University of Washington, Seattle, WA, USA
| | - Kerstin Edlefsen
- Department of Laboratory Medicine, Hematopathology Division, University of Washington, Seattle, WA, USA
| | - Florencia Jalikis
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela S Becker
- Division of Hematology, Department of Medicine, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Cunningham I, Worthley D. Leukemia in gastrointestinal organs as cause of treatment failure: 378 cases analyzed. Am J Hematol 2018; 93:1327-1336. [PMID: 30105897 DOI: 10.1002/ajh.25250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 07/31/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
Leukemia growing as tumors in gastrointestinal organs is an under-investigated cause of treatment failure and death. These present with symptoms often mistaken for common toxicities but may grow large before symptoms. To synthesize experience available only in case reports, 378 were analyzed. Invasive and metastatic behavior typical of solid GI tumors was revealed even when marrow was uninvolved. Within 3 months of diagnosis, 33% had died, 47% within 1 year. Survivals of 4 to 18 years after involvement suggest cure is possible. Evidence is presented that combined local and systemic therapy has successfully treated GI leukemic tumors when identified early.
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Affiliation(s)
- Isabel Cunningham
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Daniel Worthley
- Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
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Lee KF, Tsai YT, Lin CY, Hsieh CB, Wu ST, Ke HY, Lin YC, Lin FY, Lee WH, Tsai CS. Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan. PLoS One 2016; 11:e0155602. [PMID: 27196400 PMCID: PMC4873185 DOI: 10.1371/journal.pone.0155602] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/02/2016] [Indexed: 12/20/2022] Open
Abstract
Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396), comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04). Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.
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Affiliation(s)
- Kwai-Fong Lee
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Biobank Management Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Bao Hsieh
- Division of General Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Sheng-Tang Wu
- Division of Urology, Tri-Service General Hospital, Taipei, Taiwan
| | - Hung-Yen Ke
- Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Chang Lin
- Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Feng-Yen Lin
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wei-Hwa Lee
- Department of Pathology, Taipei Medical University Shuang-Ho Hospital, New Taipei, Taiwan
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Sung Tsai
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
- Division of Cardiovascular Surgery, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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8
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Donor-derived myeloid sarcoma in two kidney transplant recipients from a single donor. Case Rep Nephrol 2015; 2015:821346. [PMID: 25977825 PMCID: PMC4419238 DOI: 10.1155/2015/821346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/06/2015] [Indexed: 11/17/2022] Open
Abstract
We report the rare occurrence of donor-derived myeloid sarcoma in two kidney transplant patients who received organs from a single deceased donor. There was no evidence of preexisting hematologic malignancy in the donor at the time of organ recovery. Both recipients developed leukemic involvement that appeared to be limited to the transplanted organ. Fluorescence in situ hybridization (FISH) and molecular genotyping analyses confirmed that the malignant cells were of donor origin in each patient. Allograft nephrectomy and immediate withdrawal of immunosuppression were performed in both cases; systemic chemotherapy was subsequently administered to one patient. Both recipients were in remission at least one year following the diagnosis of donor-derived myeloid sarcoma. These cases suggest that restoration of the immune system after withdrawal of immunosuppressive therapy and allograft nephrectomy may be sufficient to control HLA-mismatched donor-derived myeloid sarcoma without systemic involvement.
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Alhuraiji A, Chebbo W, El-Gohary G, Chaudhri N, Almohareb F, Ibrahim K, Bakshi N, Mohammed S, Abalkhail H, Osman SA. Donor-derived extramedullary acute promyelocytic leukemia post kidney transplant. Ann Hematol 2014; 94:505-7. [DOI: 10.1007/s00277-014-2200-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
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Extramedullary acute myelocytic leukemia following liver transplantation for VOD with immunodeficiency. J Pediatr Gastroenterol Nutr 2011; 53:346-9. [PMID: 21865981 DOI: 10.1097/mpg.0b013e318211c581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nagy M, Rascon J, Massenkeil G, Ebell W, Roewer L. Evaluation of whole-genome amplification of low-copy-number DNA in chimerism analysis after allogeneic stem cell transplantation using STR marker typing. Electrophoresis 2006; 27:3028-37. [PMID: 16807933 DOI: 10.1002/elps.200500813] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Whole-genome DNA amplification (WGA) is a promising method that generates large amounts of DNA from samples of limited quantity. We investigated the accuracy of a multiplex PCR approach to WGA over STR loci. The amplification bias within a locus and over all analyzed loci was investigated in relation to the amount of template in the WGA reaction, the specific STR locus, and allele length. We observed reproducible error-free STR profiles with 10 ng down to 1 ng of DNA template. The amplification deviation at a locus and between loci was within the intra-method reproducibility. WGA is the method of choice for amplifying nanogram amounts of genomic DNA for different applications. We detected unbalanced STR amplifications at one locus and between loci, allelic drop-outs, and additional alleles after WGA of low-copy-number DNA. We found that the high number of drop-outs and drop-ins could be eradicated using pooled DNA from separate WGA reactions even with as little as 100 pg of starting template. Nevertheless, the quality of the results was still not sufficient for use in routine chimerism analysis of limited specific cell populations after allogeneic stem cell transplantation.
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Affiliation(s)
- Marion Nagy
- Institute of Legal Medicine, Charité, University Medicine Berlin, Hannoversche Strasse 6, D-10115 Berlin, Germany.
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