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Acquired myeloma-associated Type III hyperlipidaemia treated by nonmyeloablative HLA-identical sibling allogeneic stem cell transplant using a donor with essential thrombocythaemia (ET): evidence of engraftment without manifestation of ET in recipient

Bone Marrow Transplantation volume 35, pages 1213–1214 (2005)Cite this article

We report the first case of an allogeneic stem cell transplant using a donor with essential thrombocythaemia (ET) with subsequent attainment of complete remission (CR) and no manifestation of ET in the recipient. A 48-year-old man presented with poor prognosis stage III multiple myeloma (MM) in October 2001. Immunoglobulin (Ig) G level was 72 g/l with monoclonal IgG paraprotein and free monoclonal lambda light chains in serum and urine. Bone marrow examination revealed 58% plasma cells with blastic morphology. Skeletal survey was normal, but β2-microglobulin was raised at 5.97 mg/l. He received chemotherapy with six courses of vincristine, adriamycin and dexamethasone (VAD), and then proceeded to high-dose melphalan conditioning with an autologous peripheral blood stem cell transplant in May 2002 when his IgG was 27 g/l. Maintenance treatment with prednisone was then commenced while awaiting an HLA-identical sibling nonmyeloablative allogeneic transplant (NMAT).

His potential donor, a 52-year-old sister, however, had been diagnosed with ET in April 2002 when she presented with a platelet count of 777 × 109/l. She had persisting thrombocytosis for the preceding 4 years. Serum ferritin and C-reactive protein were normal. Abdominal ultrasound revealed a normal-sized spleen. Bone marrow aspirate and trephine (BMAT) showed a marked increase in enlarged megakaryocytes with clustering and increased nuclear lobularity. Analysis for BCR/ABL fusion gene was negative. She was commenced on hydroxyurea (HU) with improvement in platelet count to 382 × 109/l by October 2002. Ethical issues arose with regard to her suitability as a donor as well as donor safety during withdrawal of drug treatment at the time of the harvest. Ethics Committee recommendations were that the transplant could proceed if the transplant was deemed beneficial and if both donor and recipient were able to give informed consent. HU was changed to anagrelide prior to harvest. However, she could not tolerate anagrelide and HU was recommenced. HU was tailed off over 2 weeks prior to a nonprimed bone marrow harvest, which yielded 5 × 106 CD34+ cells/kg. Her platelet counts remained stable during this period ranging from 350 to 408 × 109/l. NMAT proceeded in December 2002 (when IgG was 5.6 g/l), following total body irradiation (200 cGy) and fludarabine (90 mg/m2) conditioning and graft-versus-host disease (GVHD) prophylaxis with tacrolimus and mycophenolate mofetil. Donor T-cell and neutrophil engraftments are documented in Table 1. BMAT on Day 55 post-NMAT showed 1% plasma cells.

Table 1 Donor T-cell and neutrophil engraftment in peripheral blood as assessed by sex chromosome FISH analysis
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Acknowledgements

We are grateful to Professor Tony Green for advice on donor management.

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Authors and Affiliations

  1. Department of Haematology, Christchurch Hospital, New Zealand

    L Chee, R L Spearing, A Ebbett & W N Patton

  2. Department of Pathology, Cancer Genetics Research Group, Christchurch School of Medicine and Health Sciences, New Zealand

    C M Morris & M McDonald

  3. Molecular Haematology, Canterbury Health Laboratories, Christchurch, New Zealand

    V Hanrahan

  4. Lipid and Diabetes Research Centre, Christchurch Hospital, New Zealand

    R Scott

  5. Department of Biochemistry, Canterbury Health Laboratories, Christchurch, New Zealand

    C Florkowski & T Walmsley

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Chee, L., Spearing, R., Morris, C. et al. Acquired myeloma-associated Type III hyperlipidaemia treated by nonmyeloablative HLA-identical sibling allogeneic stem cell transplant using a donor with essential thrombocythaemia (ET): evidence of engraftment without manifestation of ET in recipient. Bone Marrow Transplant 35, 1213–1214 (2005). https://doi.org/10.1038/sj.bmt.1704973

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