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Donor cell-derived acute myeloid leukemia after unrelated umbilical cord blood transplantation

Leukemia volume 20, pages 744–745 (2006)Cite this article

The most frequent cause of treatment failure after allogeneic stem cell transplantation (SCT) for leukemia is relapse of the underlying host leukemia. However, rare cases have been reported in which cytogenetic analysis, alone or in combination with molecular analysis, has indicated that the new leukemia originated in the donor cells.1 Donor cell leukemia (DCL) is a rare event of unknown incidence after allogeneic SCT.

The development of DCL after allogeneic SCT is a very rare event. Witherspoon et al.3 reported six cases of secondary leukemia among 2246 bone marrow transplantations. Four of these were DCL in which the secondary leukemia from the host cells differed from the primary disease morphologically. DCL arising after SCT might be underestimated, as chimerism analysis is often difficult and cytogenetic studies alone are sometimes misleading.4 In our case, cytogenetic study at relapse after CBT indicated a normal karyotype, despite the fact that chromosomal abnormalities were noted at the initial diagnosis. Furthermore, molecular analysis using STR proved the de novo leukemia to be of donor origin. In bone marrow transplantation, the average onset time for DCL is 30 months (from 2 months to 11 years) from transplantation to relapse,1 which is longer than the average relapse with a host cell origin. Our case occurred 11 months following transplantation, and thus belongs to an early onset class of donor cell-origin leukemia. The analysis of DCL has provided a few insights into leukemogenesis. Postulated mechanisms for development of DCL include (1) occult leukemia in the donor, (2) transfer of oncogenic material from host to donor cells, (3) impaired immune surveillance, (4) drug therapy (delayed effects of various pre-transplant conditioning regimens may last long enough to affect the newly arriving donor cells) and so on. Nevertheless, it has never been possible to prove the exact mechanism responsible for DCL development on an individual basis.

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  1. Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan

    T Ando, T Yujiri, N Mitani, H Takeuchi, J Nomiyama, M Suguchi, A Matsubara & Y Tanizawa

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  1. T Ando
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  2. T Yujiri
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Ando, T., Yujiri, T., Mitani, N. et al. Donor cell-derived acute myeloid leukemia after unrelated umbilical cord blood transplantation. Leukemia 20, 744–745 (2006). https://doi.org/10.1038/sj.leu.2404121

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