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Wang Q, Xu H, Yu W, Sun L, Zhao H, Shi X. Transformation of Severe Aplastic Anemia into Donor Cell Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: A Rare Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943801. [PMID: 38632857 DOI: 10.12659/ajcr.943801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important treatment for severe aplastic anemia (SAA). It is known that SAA can evolve into malignant clonal diseases, such as acute myeloblastic leukemia (AML) or myelodysplastic syndrome. However, the transformation of SAA into AML after allo-HSCT is a rare phenomenon. Here, we report a case of SAA transformed into AML after patient received human leucocyte antigen (HLA)-matched sibling peripheral blood stem cell transplantation. CASE REPORT A 51-year-old female patient presented with petechiae and fatigue and received a diagnosis of idiopathic SAA. The immunosuppressive therapy combined with umbilical cord blood transplantation failed for this patient. Then, she received HLA-matched sibling allogeneic peripheral blood stem cell transplantation (allo-PBSCT). However, 445 days after allo-PBSCT, the patient had a diagnosis of AML by bone marrow puncture. Donor-recipient chimerism monitoring and cytogenetic analysis confirmed that the leukemia was donor cell origin. Notably, a new HOXA11 mutation was detected in the peripheral blood of the patient after transplantation by whole-exome sequencing, which was the same gene mutation detected in the donor. The patient received 1 cycle of induction chemotherapy with azacytidine and achieved complete remission. However, the leukemia relapsed after 2 cycles of consolidation chemotherapy. Unfortunately, the patient died of leukemia progression 575 days after allo-HSCT. CONCLUSIONS The mechanism of how normal donor hematopoietic cells transform to leukemia in the host remains unclear. Donor cell leukemia provides a unique opportunity to examine genetic variations in donors and hosts with regards to the progression to malignancy.
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Affiliation(s)
- Qianqian Wang
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Hong Xu
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Wei Yu
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Lingjie Sun
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Hongguo Zhao
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
| | - Xue Shi
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (mainland)
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Williams L, Doucette K, Karp JE, Lai C. Genetics of donor cell leukemia in acute myelogenous leukemia and myelodysplastic syndrome. Bone Marrow Transplant 2021; 56:1535-1549. [PMID: 33686252 DOI: 10.1038/s41409-021-01214-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 01/31/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is an important therapeutic modality for patients with acute myelogenous leukemia (AML) with poor risk features. Nonetheless, roughly 30% of such patients have leukemia recurrence and up to 2% of these are donor-derived leukemias, in which malignancy develops in the donor's transplanted cells, despite extremely low rates of leukemia in the donors themselves. Notably, over 20% of these malignancies carry chromosome 7 abnormalities nearly all of which are monosomies. Recent advances in whole exome and genome sequencing have allowed for detection of candidate genes that likely contribute to the development of AML in donor cells (donor leukemia, DCL). These genes include CEBPA, GATA2, JAK2, RUNX1, DDX41, EZH2, IDH1/2, DNMT3A, ASXL1, XPD, XRCC3, and CHEK1. The potential roles of variants in these genes are evaluated based on familial clustering of MDS/AML and corresponding animal studies demonstrating their leukemogenic nature. This review describes the spectrum of genetic aberrations detected in DCL cases in the literature with regard to the character of the individual cases, existing family cohorts that carry individual genes, and functional studies that support etiologic roles in AML development. DCL presents a unique opportunity to examine genetic variants in the donors and recipients with regards to progression to malignancy.
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Affiliation(s)
- Lacey Williams
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Kimberley Doucette
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Judith E Karp
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Catherine Lai
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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Aikawa V, Porter D, Luskin MR, Bagg A, Morrissette JJD. Transmission of an expanding donor-derived del(20q) clone through allogeneic hematopoietic stem cell transplantation without the development of a hematologic neoplasm. Cancer Genet 2015; 208:625-9. [PMID: 26628205 DOI: 10.1016/j.cancergen.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
Donor cell leukemia is a rare complication of allogeneic hematopoietic stem cell transplantation (HSCT), which may result from the development of a new malignancy in previously healthy donor cells after transplant into the recipient, or it may derive from the transmission of an occult leukemia from donor to recipient. We report a case of donor derived 20q11.2 deletion in a male patient who received an allogeneic HSCT from his HLA-identical sister for the treatment of his chronic lymphocytic leukemia. Bone marrow cells from the donor were found to contain the 20q deletion that expanded over time, but which was absent in her peripheral blood cells. Although cases of donor cell leukemia after HSCT have been reported, in this case there has been no evidence of an associated hematologic neoplasm in either the donor or recipient. Pre-transplant donor bone marrow evaluations are not practical or warranted, however the finding of new cytogenetic abnormalities after transplant mandates a thorough evaluation of the donor.
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Affiliation(s)
- Vania Aikawa
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Porter
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Marlise R Luskin
- Division of Hematology and Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Bobadilla-Morales L, Pimentel-Gutiérrez HJ, Gallegos-Castorena S, Paniagua-Padilla JA, Ortega-de-la-Torre C, Sánchez-Zubieta F, Silva-Cruz R, Corona-Rivera JR, Zepeda-Moreno A, González-Ramella O, Corona-Rivera A. Pediatric donor cell leukemia after allogeneic hematopoietic stem cell transplantation in AML patient from related donor. Mol Cytogenet 2015; 8:5. [PMID: 25674158 PMCID: PMC4324859 DOI: 10.1186/s13039-014-0105-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/26/2014] [Indexed: 12/26/2022] Open
Abstract
Here we present a male patient with acute myeloid leukemia (AML) initially diagnosed as M5 and with karyotype 46,XY. After induction therapy, he underwent a HLA-matched allogeneic hematopoietic stem cell transplantation, and six years later he relapsed as AML M1 with an abnormal karyotype //47,XX,+10[2]/47,XX,+11[3]/48,XX,+10,+11[2]/46,XX[13]. Based on this, we tested the possibility of donor cell origin by FISH and molecular STR analysis. We found no evidence of Y chromosome presence by FISH and STR analysis consistent with the success of the allogeneic hematopoietic stem cell transplantation from the female donor. FISH studies confirmed trisomies and no evidence of MLL translocation either p53 or ATM deletion. Additionally 28 fusion common leukemia transcripts were evaluated by multiplex reverse transcriptase-polymerase chain reaction assay and were not rearranged. STR analysis showed a complete donor chimerism. Thus, donor cell leukemia (DCL) was concluded, being essential the use of cytological and molecular approaches. Pediatric DCL is uncommon, our patient seems to be the sixth case and additionally it presented a late donor cell leukemia appearance. Different extrinsic and intrinsic mechanisms have been considered to explain this uncommon finding as well as the implications to the patient.
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Affiliation(s)
- Lucina Bobadilla-Morales
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,Instituto de Investigación en Cáncer de la Infancia y la Adolescencia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco México.,Unidad de Citogenética, Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,División de Pediatría, Centro de Registro e Investigación sobre Anomalías Congénitas (CRIAC), Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Helia J Pimentel-Gutiérrez
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,Unidad de Citogenética, Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Sergio Gallegos-Castorena
- Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Jenny A Paniagua-Padilla
- Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Citlalli Ortega-de-la-Torre
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,Unidad de Citogenética, Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,División de Pediatría, Centro de Registro e Investigación sobre Anomalías Congénitas (CRIAC), Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Fernando Sánchez-Zubieta
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,Instituto de Investigación en Cáncer de la Infancia y la Adolescencia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco México.,Unidad de Citogenética, Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Rocio Silva-Cruz
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,División de Pediatría, Centro de Registro e Investigación sobre Anomalías Congénitas (CRIAC), Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Jorge R Corona-Rivera
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,División de Pediatría, Centro de Registro e Investigación sobre Anomalías Congénitas (CRIAC), Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Abraham Zepeda-Moreno
- Instituto de Investigación en Cáncer de la Infancia y la Adolescencia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco México
| | - Oscar González-Ramella
- Instituto de Investigación en Cáncer de la Infancia y la Adolescencia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco México.,Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México
| | - Alfredo Corona-Rivera
- Laboratorio de Citogenética, Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona Rivera"/Doctorado de Biología Molecular, Departamento de Biología Molecular y Genómica, Universidad de Guadalajara, Guadalajara, Jalisco México.,Instituto de Investigación en Cáncer de la Infancia y la Adolescencia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco México.,Unidad de Citogenética, Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,Servicio de Hematología y Oncología Pediátrica, División de Pediatría, Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,División de Pediatría, Centro de Registro e Investigación sobre Anomalías Congénitas (CRIAC), Nuevo Hospital Civil de Guadalajara, "Dr. Juan I. Menchaca", Guadalajara, Jalisco México.,Laboratorio de Citogenética Genotoxicidad y Biomonitoreo, Instituto de Genética Humana "Dr. Enrique Corona-Rivera", Departamento de Biología Molecular y Genómica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, #Sierra Mojada 950, S.L., Edificio P, Nivel 2, Col. Independencia, Guadalajara, Jalisco CP: 44340 México
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