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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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2
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Ietto G, Gritti M, Pettinato G, Carcano G, Gasperina DD. Tumors after kidney transplantation: a population study. World J Surg Oncol 2023; 21:18. [PMID: 36691019 PMCID: PMC9869548 DOI: 10.1186/s12957-023-02892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
One of the main causes of post-transplant-associated morbidity and mortality is cancer. The aims of the project were to study the neoplastic risk within the kidney transplant population and identify the determinants of this risk. A cohort of 462 renal transplant patients from 2010 to 2020 was considered. The expected incidence rates of post-transplant cancer development in the referenced population, the standardized incidence ratios (SIR) taking the Italian population as a comparison, and the absolute risk and the attributable fraction were extrapolated from these cohorts of patients. Kidney transplant recipients had an overall cancer risk of approximately three times that of the local population (SIR 2.8). A significantly increased number of cases were observed for Kaposi's sarcoma (KS) (SIR 195) and hematological cancers (SIR 6.8). In the first 3 years post-transplant, the risk to develop either KS or hematological cancers was four times higher than in the following years; in all cases of KS, the diagnosis was within 2 years from the transplant. Post-transplant immunosuppression represents the cause of 99% of cases of KS and 85% of cases of lymphomas, while only 39% is represented by solid tumors. Data related to the incidence, the percentages attributable to post-transplant immunosuppression, and the time of onset of neoplasms, particularly for KS and hematological tumors could help improve the management for the follow-up in these patients.
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Affiliation(s)
- Giuseppe Ietto
- grid.18147.3b0000000121724807General, Emergency and Transplant Surgery Department, ASST-Sette Laghi and University of Insubria, Varese, Italy
| | - Mattia Gritti
- grid.417728.f0000 0004 1756 8807Department of General Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Giuseppe Pettinato
- grid.38142.3c000000041936754XDepartment of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115 USA
| | - Giulio Carcano
- grid.18147.3b0000000121724807General, Emergency and Transplant Surgery Department, ASST-Sette Laghi and University of Insubria, Varese, Italy
| | - Daniela Dalla Gasperina
- grid.18147.3b0000000121724807Department of Medicine and Surgery, University of Insubria, Varese, Italy
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3
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Marchionni L, Lobo FP, Kostadinov R, Serra A, Besso FG, Deaglio S, Stratta P, Berrino M, Zanettini C, Imada EL, Omar MN, Gaidano G, Bruno B, Saglio G, Amoroso A. Donor-derived acute myeloid leukemia in solid organ transplantation. Am J Transplant 2022; 22:3111-3119. [PMID: 35979657 PMCID: PMC9897593 DOI: 10.1111/ajt.17174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
We report the transmission of acute myeloid leukemia (AML) undetected at donation from a deceased organ donor to two kidneys and one liver recipients. We reviewed the medical records, and performed molecular analyses and whole exome sequencing (WES) to ascertain AML donor origin and its molecular evolution. The liver recipient was diagnosed 11 months after transplantation and died from complications 2 months later. The two kidney recipients (R1 and R2) were diagnosed 19 and 20 months after transplantation and both received treatment for leukemia. R1 died of complications 11 months after diagnosis, while R2 went into complete remission for 44 months, before relapsing. R2 died 10 months later of complications from allogenic bone marrow transplantation. Microsatellite analysis demonstrated donor chimerism in circulating cells from both kidney recipients. Targeted molecular analyses and medical records revealed NPM1 mutation present in the donor and recipients, while FLT3 was mutated only in R1. These findings were confirmed by WES, which revealed additional founder and clonal mutations, and HLA genomic loss in R2. In conclusion, we report the first in-depth genomic analysis of AML transmission following solid organ transplantation, revealing distinct clonal evolution, and providing a potential molecular explanation for tumor escape.
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Affiliation(s)
- Luigi Marchionni
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francisco Pereira Lobo
- Department of Genetics, Ecology and Evolution, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rumen Kostadinov
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Serra
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Federico Genzano Besso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Silvia Deaglio
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Piero Stratta
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Berrino
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Zanettini
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Eddie Luidy Imada
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed N. Omar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianluca Gaidano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Antonio Amoroso
- Immunogenetics and Transplant Biology Service, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
- Department of Medical Sciences, University of Turin, Torino, Italy
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4
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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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5
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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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6
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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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7
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Cho S, Park J, Lee M, Lee D, Choi H, Gim G, Kim L, Kang CY, Oh Y, Viveiros P, Vagia E, Oh MS, Cho GJ, Bharat A, Chae YK. Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2021; 10:1700-1710. [PMID: 34012786 PMCID: PMC8107741 DOI: 10.21037/tlcr-20-933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. Methods We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. Results We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14–1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15–1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07–1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08–1.69, P=0.008). Conclusions Blood transfusions were associated with decreased survival of patients with lung cancer.
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Affiliation(s)
- Sukjoo Cho
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonghanne Park
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Misuk Lee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongyup Lee
- Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA
| | - Horyun Choi
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gahyun Gim
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Leeseul Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cyra Y Kang
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Youjin Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pedro Viveiros
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elena Vagia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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8
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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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9
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Sasaki K, Mori Y, Yoshimoto G, Sakoda T, Kato K, Inadomi K, Kamezaki K, Takenaka K, Iwasaki H, Maeda T, Miyamoto T, Akashi K. Successful treatment of Ph ALL with hematopoietic stem cell transplantation from the same HLA-haploidentical related donor of previous liver transplantation. Leuk Lymphoma 2017; 59:2005-2007. [PMID: 29164981 DOI: 10.1080/10428194.2017.1403021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kensuke Sasaki
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Yasuo Mori
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Goichi Yoshimoto
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Teppei Sakoda
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Koji Kato
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Kyoko Inadomi
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Kenjiro Kamezaki
- b Center for Cellular and Molecular Medicine , Kyushu University Hospital , Fukuoka , Japan
| | - Katsuto Takenaka
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Hiromi Iwasaki
- b Center for Cellular and Molecular Medicine , Kyushu University Hospital , Fukuoka , Japan
| | - Takahiro Maeda
- b Center for Cellular and Molecular Medicine , Kyushu University Hospital , Fukuoka , Japan
| | - Toshihiro Miyamoto
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Koichi Akashi
- a Department of Medicine and Biosystemic Science , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan.,b Center for Cellular and Molecular Medicine , Kyushu University Hospital , Fukuoka , Japan
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10
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Acute promyelocytic leukemia following solid organ transplantation. Ann Hematol 2015; 95:169-171. [DOI: 10.1007/s00277-015-2524-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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11
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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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12
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Peek R, Bastings L, Westphal JR, Massuger LFAG, Braat DDM, Beerendonk CCM. A preliminary study on a new model system to evaluate tumour-detection and tumour-purging protocols in ovarian cortex tissue intended for fertility preservation. Hum Reprod 2015; 30:870-6. [DOI: 10.1093/humrep/dev013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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13
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Organ transplantation from donors (cadaveric or living) with a history of malignancy: Review of the literature. Transplant Rev (Orlando) 2014; 28:169-75. [DOI: 10.1016/j.trre.2014.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/15/2014] [Accepted: 06/11/2014] [Indexed: 12/11/2022]
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14
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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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15
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Abstract
Donor cell derived malignancies are a rare and interesting complication of allogeneic bone marrow transplantation. We present a case of a 56-year-old male with donor cell myeloid sarcoma of the stomach and myocardium.
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16
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Sachdev SH, Joshi V, Cox ER, Amoroso A, Palekar S. Severe life-threatening Ehrlichia chaffeensis infections transmitted through solid organ transplantation. Transpl Infect Dis 2013; 16:119-24. [PMID: 24330198 DOI: 10.1111/tid.12172] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 06/04/2013] [Accepted: 07/31/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Donor-derived infections from organ transplantation are rare occurrences with preoperative screening practices. Ehrlichia chaffeensis, a tick-borne illness, transmitted through solid organ transplantation has not been reported previously to our knowledge. We present cases of 2 renal allograft recipients who developed severe E. chaffeensis infection after receipt of organs from a common deceased donor. METHODS The 2 renal transplant patients who developed E. chaffeensis infection are reported in case study format with review of the literature. RESULTS Approximately 3 weeks after renal transplantation, both patients developed an acute febrile illness and rapid clinical decline. Recipient A underwent an extensive infectious workup that revealed positive E. chaffeensis DNA from polymerase chain reaction on peripheral blood. Recipient B's clinical team obtained acute and convalescent antibody titers for E. chaffeensis, which demonstrated acute infection. Recipients A and B were treated with doxycycline and tigecycline, respectively, with clinical cure. CONCLUSIONS These cases demonstrate that tick-borne pathogens, such as E. chaffeensis, can be transmitted through renal transplantation. E. chaffeensis can be associated with excessive morbidity and mortality, commonly owing to delay in diagnosis and poor response to non-tetracycline antibiotics. In populations with endemic tick-borne illness, donors should be questioned about tick exposure, and appropriate antibiotics can be administered if indicated.
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Affiliation(s)
- S H Sachdev
- Nephrology, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
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18
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Liu M, Liu J, Liu L, Yu L, Shi B, Ye L, Zhang Y, Chen H. A case report of acute myeloid leukemia after liver transplantation. Acta Haematol 2013; 129:225-8. [PMID: 23295767 DOI: 10.1159/000345412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/22/2012] [Indexed: 11/19/2022]
Abstract
Acute myeloid leukemia (AML) is a rare complication observed after liver transplantation and only a handful of cases have been reported until now. We report a case of acute promyelocytic leukemia (APL) after liver transplantation in a 50-year-old man. The case presentation was postodontectomy bleeding with an associative abnormal coagulation test 85 months after liver transplantation. A routine blood test, bone marrow test, chromosome analysis and examination of PML/RARα chimeric gene confirmed the diagnosis of APL and disseminated intravascular coagulation (DIC). Induction chemotherapy with all-trans retinoic acid, arsenic trioxide and daunorubicin was given to this patient and complete remission was achieved. The patient was subjected to DA (daunorubicin combined with cytarabine) and MA (mitoxantrone combined with cytarabine) regimens after remission induction to consolidate the chemotherapy for two courses of treatment, and subsequently subjected to arsenous acid chemotherapy on a periodic basis. Twenty-two months into the follow-up, sustained bone marrow remission was observed with the adapted treatment regimen.
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Affiliation(s)
- Mingjuan Liu
- Department of Hematology, The 309th Hospital of Chinese People's Liberation Army, Beijing, China.
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19
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Cryopreserved ovarian cortex from patients with leukemia in complete remission contains no apparent viable malignant cells. Blood 2012; 120:4311-6. [DOI: 10.1182/blood-2012-01-403022] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Some women suffering from leukemia require bone marrow transplantation to be cured. Bone marrow transplantation is associated with a high risk of sterility, and some patients are offered fertility preservation by cryopreservation of the ovarian cortex. Transplantation of the ovarian cortex to women cured of leukemia who became menopausal is currently not performed because of the risk of introducing the disease. In this study, individual pieces of ovarian cortex intended for reimplantation from 25 patients with leukemia were transplanted to each of 25 nude mice for 20 weeks. The ovarian cortex was examined before and after transplantation by histology and immunohistochemistry, and RT–quantitative PCR (in the 7 patients with a known marker). Seventeen patients had the ovarian cortex retrieved when they were in complete remission. Before transplantation, 4 of 7 pieces (2 from patients in complete remission) of ovarian cortex had a positive RT–quantitative PCR. After transplantation, none of the mice revealed any sign of disease, neither in the pieces of ovarian cortex transplanted nor in any of the murine organs evaluated. Thus, the ovaries from patients in complete remission do not appear to contain viable malignant cells contrasting ovarian tissue retrieved before treatment.
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Williams T, Aljitawi OS, Moussa R, McHugh S, Dusing R, Abraha J, Yarlagadda SG. First case of donor transmitted non-leukemic promyelocytic sarcoma. Leuk Lymphoma 2012; 53:2530-4. [DOI: 10.3109/10428194.2012.695360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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21
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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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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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Ison MG, Hager J, Blumberg E, Burdick J, Carney K, Cutler J, Dimaio JM, Hasz R, Kuehnert MJ, Ortiz-Rios E, Teperman L, Nalesnik M. Donor-derived disease transmission events in the United States: data reviewed by the OPTN/UNOS Disease Transmission Advisory Committee. Am J Transplant 2009; 9:1929-35. [PMID: 19538493 DOI: 10.1111/j.1600-6143.2009.02700.x] [Citation(s) in RCA: 186] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-derived disease transmission is increasingly recognized as a source of morbidity and mortality among transplant recipients. Policy 4.7 of the Organ Procurement and Transplantation Network (OPTN) currently requires reporting of donor-derived events. All potential donor-derived transmission events (PDDTE) reported to OPTN/UNOS were reviewed by the Disease Transmission Advisory Committee (DTAC). Summary data from January 1, 2005-December 31, 2007, were prepared for presentation. Reports of PDDTE have increased from 7 in 2005, the first full year data were collected, to 60 in 2006 and to 97 in 2007. More detailed information is available for 2007; a classification system for determining likelihood of donor-derived transmission was utilized. In 2007, there were four proven and one possible donor-derived malignancy transmissions and four proven, two probable and six possible donor-derived infectious diseases transmissions. There were nine reported recipient deaths attributable to proven donor transmissions events arising from eight donors during 2007. Although recognized transmission events resulted in significant morbidity and mortality, transmission was reported in only 0.96% of deceased donor donations overall. Improved reporting, through enhanced recognition and communication, will be critical to better estimate the transmission risk of infection and malignancy through organ transplantation.
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Affiliation(s)
- M G Ison
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Jiang N, Li H, Wang GS, Zhang J, Zhang JF, Yi SH, Yang Y, Cai CJ, Lu MQ, Chen GH. Acute leukemia, a rare but fatal complication after liver transplantation. Leuk Res 2009; 33:1349-51. [PMID: 19446880 DOI: 10.1016/j.leukres.2009.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 03/26/2009] [Accepted: 03/26/2009] [Indexed: 01/20/2023]
Abstract
Little information is available about the risk factors and means to improve the survival rate of acute leukemia in a rare but often fatal complication after liver transplantation (LT). We report the development of AML-M2 in one of the 764 patients who underwent liver transplantation at our center, and review the literature on similar cases. The patient, a 42-year-old man who developed acute leukemia 38 months after liver transplantation, was successfully treated with chemotherapy and has subsequently been in remission. With appropriate adjustment of immunosuppressive agents, he was able to safely benefit from chemotherapy. Only 16 patients with acute leukemia after liver transplantation have been reported, and the mortality rate is extraordinarily high (52.94%, 9/17). More cases of acute leukemia will emerge as the rate of survival after liver transplantation increases. The patient's chromosomal mutation profile, the choice of immunosuppressive agent, and infection by hepatitis virus may be the risk factors for the development of acute leukemia after LT. Our experience suggests that clinicians should adjust the immunosuppressive agents according to the immunosuppressive state of the patient and explore the option of reducing or stopping the medication as long as liver function remains stable. These measures could help reduce the high mortality rate among these patients.
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Affiliation(s)
- Nan Jiang
- Liver Transplant Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, NO.600 TianHe Road, TianHe District, Guangzhou 510630, Guangdong Province, PR China
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25
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Lowe T, Bhatia S, Somlo G. Second malignancies after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2007; 13:1121-34. [PMID: 17889348 DOI: 10.1016/j.bbmt.2007.07.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 07/06/2007] [Indexed: 11/22/2022]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) may prolong life and cure patients suffering from otherwise fatal diseases. However, the growing population of long-term survivors has led to the realization of multiple long-term complications, including the risk of second malignancies. Compared to the autologous setting, allo-HCT carries a much higher risk of posttransplant lymphoproliferative disorder (PTLD), which usually occurs within the first year after allo-HCT and is strongly associated with the Epstein-Barr virus (EBV). Treatment-related myelodysplastic syndromes (tMDS) and second leukemias are extremely rare. Both autologous and allo-HCT carry increased risks for second solid malignancies (SSM). The cumulative incidence of SSM continues to increase in each of the largest studies with as much as 20 years of follow-up, likely related to the long latency of radiation-related SSM. Systematic, prospective monitoring, vigilant screening processes, and well-maintained survivorship clinics and databases are absolute necessities, and should be included in the infrastructure of individual transplant centers and networks, with mandatory periodic reporting of second malignancy incidences. Primary care and transplant physicians alike must be aware of the risk of second malignancies after allo-HCT. Most importantly, guidelines should be developed in regard to screening and prevention of second malignancies, so that physicians can provide state-of-the-art counsel and care for the benefit of our patients.
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Affiliation(s)
- Thomas Lowe
- City of Hope Comprehensive Cancer Center, Duarte, California 91010, USA.
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26
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Concejero A, Chen CL, Wang CC, Wang SH, Lin CC, Liu YW, Yang CH, Yong CC, Wang MC, Eng HL. Chronic Myeloid Leukemia After Living Donor Liver Transplantation. Transplantation 2007; 83:1521-2. [PMID: 17565329 DOI: 10.1097/01.tp.0000265587.17307.6a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
MESH Headings
- Antibiotics, Antineoplastic/adverse effects
- Antibiotics, Antineoplastic/therapeutic use
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Doxorubicin/adverse effects
- Doxorubicin/therapeutic use
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/etiology
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Transplantation/adverse effects
- Living Donors
- Male
- Middle Aged
- Neoplasm Invasiveness
- Postoperative Care
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27
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Edgren G, Hjalgrim H, Reilly M, Tran TN, Rostgaard K, Shanwell A, Titlestad K, Adami J, Wikman A, Jersild C, Gridley G, Wideroff L, Nyrén O, Melbye M. Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study. Lancet 2007; 369:1724-30. [PMID: 17512857 DOI: 10.1016/s0140-6736(07)60779-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although mechanisms for detection of short-term complications after blood transfusions are well developed, complications with delayed onset, notably transmission of chronic diseases such as cancer, have been difficult to assess. Our aim was to investigate the possible risk of cancer transmission from blood donors to recipients through blood transfusion. METHODS We did a register-based retrospective cohort study of cancer incidence among patients who received blood from donors deemed to have a subclinical cancer at the time of donation. These precancerous donors were diagnosed with a cancer within 5 years of the donation. Data from all computerised blood bank registers in Sweden and Denmark gathered between 1968 and 2002 were merged into a common database. Demographic and medical data, including mortality and cancer incidence, were ascertained through linkages with nationwide, and essentially complete, population and health-care registers. The risk of cancer in exposed recipients relative to that in recipients who received blood from non-cancerous donors was estimated with multivariate Poisson regression, adjusting for potential confounding factors. FINDINGS Of the 354 094 transfusion recipients eligible for this analysis, 12,012 (3%) were exposed to blood products from precancerous donors. There was no excess risk of cancer overall (adjusted relative risk 1.00, 95% CI 0.94-1.07) or in crude anatomical subsites among recipients of blood from precancerous donors compared with recipients of blood from non-cancerous donors. INTERPRETATION Our data provide no evidence that blood transfusions from precancerous blood donors are associated with increased risk of cancer among recipients compared with transfusions from non-cancerous donors.
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Affiliation(s)
- Gustaf Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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28
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Gandhi MJ, Strong DM. Donor derived malignancy following transplantation: a review. Cell Tissue Bank 2007; 8:267-86. [PMID: 17440834 DOI: 10.1007/s10561-007-9036-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 02/12/2007] [Indexed: 02/06/2023]
Abstract
Organ and tissue transplant is now the treatment of choice for many end stage diseases. In the recent years, there has been an increasing demand for organs but not a similar increase in the supply leading to a severe shortage of organs for transplant resulted in increasing wait times for recipients. This has resulted in expanded donor criteria to include older donors and donors with mild disease. In spite of implementation of more stringent criteria for donor selection, there continues to be some risk of donor derived malignancy. Malignancy after transplantation can occur in three different ways: (a) de-novo occurrence, (b) recurrence of malignancy, and (c) donor-related malignancy. Donor related malignancy can be either due to direct transmission of tumor or due to tumor arising in cells of donor origin. We will review donor related malignancies following solid organ transplantation and hematopoeitic progenitor cell transplantation. Further, we will briefly review the methods for detection and management of these donor related malignancies.
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Affiliation(s)
- Manish J Gandhi
- Department of Pathology and Immunology, Washington University, 660 S Euclid Ave #8118, St Louis, MO 63110, USA.
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29
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Sato T, Kobayashi R, Iguchi A, Nakajima M, Koizumi S, Furukawa H, Todoh S, Kobayashi K. Acute promyelocytic leukemia after living donor partial orthotopic liver transplantation in two Japanese girls. Leuk Lymphoma 2005; 46:1057-60. [PMID: 16019558 DOI: 10.1080/10428190500097706] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Organ transplant recipients are generally considered to be at greater risk for developing malignant disorders because of prolonged immunosuppression for organ grafting, but acute leukemia is a rare complication after organ transplantation (0.2 -2.5%). We encountered two girls with acute promyelocytic leukemia (APL) after living donor partial orthotopic liver transplantation. In one patient, APL developed 21 months after liver transplantation for ornithine transcarbamylase deficiency. She had been administered tacrolimus for prophylaxis of graft-versus-host reaction. In the other patient, APL was diagnosed 46 months after liver transplantation for congenital biliary atresia. Both patients were successfully treated by chemotherapy including all-trans retinoic acid (ATRA), and after reaching complete remission, they have subsequently been in continuous remission. Although leukemia after liver transplantation is generally thought of as a rare complication, increases in survival rate following liver transplantation is likely to lead to more such cases, and documentation of these cases is therefore of importance.
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Affiliation(s)
- Tomonobu Sato
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan.
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Yoshida T, Kanegane H, Otsubo K, Nomura K, Hirokawa S, Tsuneyama K, Egawa H, Miyawaki T. Acute lymphoblastic leukemia after living donor liver transplantation. Pediatr Int 2005; 47:579-82. [PMID: 16190969 DOI: 10.1111/j.1442-200x.2005.02105.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Taketoshi Yoshida
- Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan
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Abstract
Donor-derived malignancy is found in about 0.02-0.2% of allograft recipients. With an increasing number of older donors, this problem will gain more relevance in the future. We wish to review the current literature on tumor transmission with solid organ transplants and focus on the consequences of an extension of the donor pool, such as by the use of donors with a history of cancer. Finally, suggestions are made for screening regimens for living as well as cadaveric donors to minimize the risk of inadvertent tumor transmission.
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Affiliation(s)
- Christian Morath
- Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
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Niederwieser D, Gentilini C, Hegenbart U, Lange T, Moosmann P, Pönisch W, Al-Ali H, Raida M, Ljungman P, Tyndall A, Urbano-Ispizua A, Lazarus HM, Gratwohl A. Transmission of donor illness by stem cell transplantation: should screening be different in older donors? Bone Marrow Transplant 2005; 34:657-65. [PMID: 15334048 DOI: 10.1038/sj.bmt.1704588] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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, early-stage 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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Affiliation(s)
- D Niederwieser
- Department of Internal Medicine II, Division of Hematology and Oncology, University of Leipzig, Philipp Rosenthalstr. 23-25, Leipzig D-4103, Germany.
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Pedotti P, Poli F, Longhi E, Frison S, Caldara R, Chiaramonte S, Gotti E, Marchini F, Maresca C, Sandrini S, Scalamogna M, Taioli E. Epidemiologic study on the origin of cancer after kidney transplantation. Transplantation 2004; 77:426-8. [PMID: 14966419 DOI: 10.1097/01.tp.0000111757.08499.c2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Subjects who underwent solid organ transplantation are at higher risk for a wide variety of cancers. METHODS The authors investigated the origin of cancer in a cohort of 2,526 patients followed up for 60.7 +/- 35.6 months after kidney transplantation between 1990 and 2000 in seven transplant centers. RESULTS One hundred four of them developed cancer. All subjects who developed solid cancer within 6 months after transplantation (n=10) and a group of subjects who developed solid cancer after 6 months posttransplant (n=10) were selected. Short tandem repeat analysis was performed on paraffin-embedded biopsy specimens of tumors and on both donor and recipient pretransplant peripheral blood. Biologic material was obtained in 17 of the 20 selected patients (85.0%). The analysis showed that 16 of 17 tumors were genetically identical to the recipient. CONCLUSIONS The authors' results suggest that donor transmission of solid cancer is an unlikely event in their population.
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Affiliation(s)
- Paola Pedotti
- Molecular and Genetic Epidemiology Unit, IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
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Camós M, Esteve J, Rimola A, Grande L, Rozman M, Colomer D, Villamor N, Costa D, Montserrat E. Increased incidence of acute myeloid leukemia after liver transplantation? Description of three new cases and review of the literature. Transplantation 2004; 77:311-3. [PMID: 14743000 DOI: 10.1097/01.tp.0000102549.40531.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myeloid leukemia (AML) after solid organ transplantation is rare, with only six AML cases after liver transplantation (LT) being reported. METHODS Characteristics of three AML cases observed among 799 recipients of LT in the authors' institution and estimation of the standardized incidence ratio (SIR) are presented. RESULTS Three AML cases were diagnosed (French-American-British classification subtypes M0, M3, and M1) at 38 days, 2 years, and 3.5 years after LT, respectively. The immunosuppressive regimen consisted of cyclosporine A and prednisone. The recipient's origin of blasts could be demonstrated in two cases. All patients achieved complete remission after standard treatment. Nonetheless, disease relapsed in two patients at 2 and 6 months, whereas the patient with acute promyelocytic leukemia remains disease-free 4 years after diagnosis. As compared with the general population, the observed incidence of AML in the authors' series of LT results in a significantly higher SIR of 11.41 (P=0.0023). CONCLUSIONS The higher SIR found in the authors' series suggests an increased risk of AML in patients undergoing LT.
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Affiliation(s)
- Mireia Camós
- Department of Hematology, Hemopathology Unit, Institute of Hematology and Oncology, Hospital Clínic, Barcelona, Spain
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Au WY, Hung KN, Loong F, Ma SK. Patients presenting with CNS lesions. Case 3. Sequential myeloproliferative disease and glioblastoma multiforme in a renal transplant recipient. J Clin Oncol 2003; 21:4062-3. [PMID: 14581430 DOI: 10.1200/jco.2003.11.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- W Y Au
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Barozzi P, Luppi M, Facchetti F, Mecucci C, Alù M, Sarid R, Rasini V, Ravazzini L, Rossi E, Festa S, Crescenzi B, Wolf DG, Schulz TF, Torelli G. Post-transplant Kaposi sarcoma originates from the seeding of donor-derived progenitors. Nat Med 2003; 9:554-61. [PMID: 12692543 DOI: 10.1038/nm862] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 03/24/2003] [Indexed: 01/23/2023]
Abstract
Kaposi sarcoma (KS) is a vascular tumor that can develop in recipients of solid tissue transplants as a result of either primary infection or reactivation of a gammaherpesvirus, the KS- associated herpesvirus, also known as human herpesvirus-8 (HHV-8). We studied whether HHV-8 and the elusive KS progenitor cells could be transmitted from the donor through the grafts. We used a variety of molecular, cytogenetic, immunohistochemical and immunofluorescence methods to show that the HHV-8-infected neoplastic cells in post-transplant KS from five of eight renal transplant patients harbored either genetic or antigenic markers of their matched donors. These data suggest the use of donor-derived HHV-8-specific T cells for the control of post-transplant KS.
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Affiliation(s)
- Patrizia Barozzi
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
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Haltrich I, Müller J, Szabó J, Kovács G, Kóos R, Poros A, Dobos M, Fekete G. Donor-cell myelodysplastic syndrome developing 13 years after marrow grafting for aplastic anemia. CANCER GENETICS AND CYTOGENETICS 2003; 142:124-8. [PMID: 12699888 DOI: 10.1016/s0165-4608(02)00804-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Donor-cell-derived hematopoietic malignancy is a rare event after bone marrow transplantation. Most cases in the literature occurred within the first year. We present a rare case of a female patient who had a bone marrow transplant for severe aplastic anemia (SAA) at the age of two and a half years from her human leukocyte antigen-identical brother. She developed a myelodysplastic syndrome (refractory cytopenia with multilineage dysplasia) 12 years later. Initially, the malignant clone was of recipient origin, but within several months, progression to a clinically more aggressive refractory anemia with excess blasts (RAEB) was accompanied by the outgrowth of a new clone of donor origin. In this report we provide evidence proving that the patient's final malignant clone arose in donor cells: cytogenetic analysis of the marrow showed a male karyotype and a t(3;21)(q26;q21) in all 62 metaphases analyzed. Interphase fluorescence in situ hybridization showed that all identifiable cells contained the Y chromosome. We conclude that donor-cell-derived hematopoietic malignancy after bone marrow transplantation can occur even after many years. We believe that the 13 years that elapsed between the transplant and the development of RAEB in our case represent the longest latency period in the literature.
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Affiliation(s)
- Irén Haltrich
- II Department of Pediatrics, Faculty of Medicine, Semmelweis University, H-1094 Budapest, Hungary.
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Myron Kauffman H, McBride MA, Cherikh WS, Spain PC, Hanto DW, Delmonico FL. Donor-related malignancies. Transplant Rev (Orlando) 2002. [DOI: 10.1053/trte.2002.128240] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Myron Kauffman H, McBride MA, Cherikh WS, Spain PC, Marks WH, Roza AM. Transplant tumor registry: donor related malignancies. Transplantation 2002; 74:358-62. [PMID: 12177614 DOI: 10.1097/00007890-200208150-00011] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transmission of donor malignancies has been intermittently reported since the early days of clinical transplantation. The incidence of United States donor related malignancies has not previously been documented. METHODS All donor related malignancies reported to the Organ Procurement and Transplantation Network/United Network for Organ Sharing from 4/1/94-7/1/01 in a cohort of 34,933 cadaveric donors and 108,062 recipients were investigated by contacting the transplant centers to verify that the reported tumors were of donor origin. Time and mode of discovery, as well as graft and patient outcome, were determined. The status of other recipients from the donor was investigated. RESULTS A total of 21 donor related malignancies from 14 cadaveric and 3 living donors were reported. Fifteen tumors were donor transmitted and 6 were donor derived. Transmitted tumors are malignancies that existed in the donor at the time of transplantation. Derived tumors are de novo tumors that develop in transplanted donor hematogenous or lymphoid cells after transplantation. The cadaveric donor related tumor rate is 0.04% (14 of 34,993). The donor related tumor rate among transplanted cadaveric organs is 0.017% (18 of 108,062). Among patients developing donor related malignancies, the overall mortality rate was 38%, with that of transmitted tumors being 46% and derived tumors being 33%. The cadaveric donor related tumor mortality rate is 0.007% (8 of 108,062). CONCLUSIONS The United States incidence of donor related tumors is extremely small. The donor related tumor death rate is also extremely small, particularly when compared with waiting-list mortality.
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Affiliation(s)
- H Myron Kauffman
- Research Department, United Network for Organ Sharing, Richmond, VA 23225, USA.
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Chow EJ, Holly EA. Blood transfusions as a risk factor for non-Hodgkin's lymphoma in the San Francisco Bay Area: a population-based study. Am J Epidemiol 2002; 155:725-31. [PMID: 11943690 DOI: 10.1093/aje/155.8.725] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The incidence of non-Hodgkin's lymphoma (NHL) has risen dramatically over the past 50 years. In the search for new risk factors, blood transfusions have been investigated and shown to be associated with subsequent lymphoma in some studies. The authors tested this association in a population-based, case-control study conducted between 1988 and 1995 in the San Francisco Bay Area of California. A total of 1,591 histologically confirmed adult cases of NHL were included in this study. Cases were frequency matched to 2,515 control participants by sex, county of residence, and 5-year age intervals. Multivariate logistic regression models were used to examine the impact of possible confounders. Persons who reported a history of allogeneic transfusion were not at increased risk of NHL in this population (odds ratio (OR) = 1.0, 95% confidence interval (CI): 0.84, 1.2). No significant associations were seen when lymphomas were stratified by histologic subtype, grade, or latency period. However, autologous transfusions were associated with a decreased risk (OR = 0.39, 95% CI: 0.16, 0.94). In summary, these findings are similar to those of prior negative studies and do not support some previous reports of an adverse association between blood transfusion and NHL.
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Affiliation(s)
- Eric J Chow
- School of Medicine, University of California, San Francisco, CA 94118-1944, USA
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Abstract
INTRODUCTION Acute leukemia is rare after solid organ transplantation. METHODS Review of data on 3 patients with acute leukemia identified among 1365 who underwent liver transplantation at our center, and a review of the literature. RESULTS In patient 1, AML-M4 developed 19 months after transplant for cryptogenic cirrhosis. In patient 2, B cell acute lymphoid leukemia was diagnosed 10 months after liver transplant for fulminant hepatitis. Both patients had normal cytogenetics, and achieved complete remission with chemotherapy. In patient 3, acute monocytic leukemia-M3 with t(15;17) arose 18 months after transplant for hepatitis C cirrhosis. This patient received treatment with retinoic acid and chemotherapy, but developed a disseminated intravascular coagulation and died before completing therapy. No patient presented with chromosomal abnormalities commonly seen in secondary leukemia. The latency period to diagnosis after transplant was 10-19 months. CONCLUSIONS Acute leukemia, although rare after liver transplantation, should be considered in the differential diagnosis of hematological complications.
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Affiliation(s)
- C A Doti
- Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA
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Berg KD, Brinster NK, Huhn KM, Goggins MG, Jones RJ, Makary A, Murphy KM, Griffin CA, Rosenblum-Vos LS, Borowitz MJ, Nousari HC, Eshleman JR. Transmission of a T-cell lymphoma by allogeneic bone marrow transplantation. N Engl J Med 2001; 345:1458-63. [PMID: 11794194 DOI: 10.1056/nejmoa010041] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Bone Marrow Transplantation/adverse effects
- Disease Transmission, Infectious
- Female
- Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor
- Humans
- Lymphoma, Large-Cell, Anaplastic/complications
- Lymphoma, Large-Cell, Anaplastic/drug therapy
- Lymphoma, Large-Cell, Anaplastic/therapy
- Lymphoma, T-Cell/etiology
- Lymphoma, T-Cell/genetics
- Microsatellite Repeats
- Middle Aged
- Panniculitis/etiology
- Panniculitis/genetics
- Polymerase Chain Reaction
- Sequence Analysis, DNA
- Transplantation, Homologous
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Affiliation(s)
- K D Berg
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Bodvarsson S, Burlingham W, Kusaka S, Hafez GR, Becker BN, Pintar T, Sollinger HW, Albertini MR. Donor-derived small cell lung carcinoma in a kidney transplant recipient. Cancer 2001; 92:2429-34. [PMID: 11745300 DOI: 10.1002/1097-0142(20011101)92:9<2429::aid-cncr1592>3.0.co;2-g] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Transplantation of donor-derived malignancies during organ transplantation fortunately is very rare. Discontinuation of immunosuppressive medications under these circumstances has previously resulted in complete tumor rejection. Ectopic adrenocorticotropic hormone (ACTH) production may result in Cushing syndrome and is not an uncommon paraneoplastic feature of small cell carcinoma of the lung. Theoretically, in the organ transplantation setting, the resulting high cortisol levels could suppress a tumor-rejection immune response. However, to the authors' knowledge, no such clinical scenario has been described in the literature published to date. METHODS A 25-year-old living related kidney transplant recipient presented with Cushing syndrome 32 months after transplantation. The donor had been diagnosed with small cell carcinoma of the lung 22 months earlier. On further evaluation, the kidney recipient was diagnosed with donor-derived small cell lung carcinoma of the transplanted kidney. She was found to have extensive disease involving the liver and retroperitoneum. Despite discontinuation of immunosuppressive medications, the disease progressed and cortisol levels remained elevated during 6 weeks of observation. RESULTS The patient received six cycles of cisplatin and etoposide, which resulted in resolution of her hypercortisolemia and a complete remission of her donor-derived small cell carcinoma. At last follow-up, she was 12 months from completing her therapy and continued in complete remission. CONCLUSIONS Donor-derived small cell carcinoma and ectopic ACTH production can occur in a patient after kidney transplantation.
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Affiliation(s)
- S Bodvarsson
- Department of Internal Medicine, Clinical Science Center, University of Wisconsin Medical School, 600 Highland Avenue, Madison, WI 53792, USA
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Affiliation(s)
- A G Sheil
- Departments of Surgery, Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
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Abstract
Lymphoid and dendritic cells of donor origin can be detected in the recipient several years after a solid organ transplantation. This phenomenon is termed microchimerism and could play a role in the induction of tolerance. The fate of other hematopoietic cells transferred by liver transplantation, in particular of stem and progenitor cells, is unknown. For this reason, we studied peripheral blood and bone marrow samples of 12 patients who had received a liver transplant from an HLA-DR mismatched donor. Eight patients were long-term survivors between 2.8 and 10.1 years after allografting. CD34+ cells from bone marrow were highly enriched with the use of a 2-step method, and a nested polymerase chain reaction was applied to detect donor cells on the basis of allelic differences of the HLA-DRB1 gene. Rigorous controls with DRB1 specificities equal to the donor and host were included. In 5 of 8 long-term liver recipients, donor-specific CD34+ cells could be detected in bone marrow. Microchimerism in the CD34+ cell fraction did not correlate to the chimeric status in peripheral blood. In conclusion, our results demonstrate a frequent microchimerism among bone marrow–derived CD34+ cells after liver transplantation. The functional role of this phenomenon still needs to be defined.
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Abstract
Abstract
Lymphoid and dendritic cells of donor origin can be detected in the recipient several years after a solid organ transplantation. This phenomenon is termed microchimerism and could play a role in the induction of tolerance. The fate of other hematopoietic cells transferred by liver transplantation, in particular of stem and progenitor cells, is unknown. For this reason, we studied peripheral blood and bone marrow samples of 12 patients who had received a liver transplant from an HLA-DR mismatched donor. Eight patients were long-term survivors between 2.8 and 10.1 years after allografting. CD34+ cells from bone marrow were highly enriched with the use of a 2-step method, and a nested polymerase chain reaction was applied to detect donor cells on the basis of allelic differences of the HLA-DRB1 gene. Rigorous controls with DRB1 specificities equal to the donor and host were included. In 5 of 8 long-term liver recipients, donor-specific CD34+ cells could be detected in bone marrow. Microchimerism in the CD34+ cell fraction did not correlate to the chimeric status in peripheral blood. In conclusion, our results demonstrate a frequent microchimerism among bone marrow–derived CD34+ cells after liver transplantation. The functional role of this phenomenon still needs to be defined.
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