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Graft vs GIST?

Bone Marrow Transplantation volume 47, pages 1246–1247 (2012)Cite this article

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Physicians specializing in hematopoietic SCT (HSCT) occasionally encounter the difficult situation of deciding whether to proceed with an allogeneic HSCT for a high-risk hematologic malignancy in a patient who has a different concomitant incurable but treatable low-grade neoplasm. In such patients, the risk of the low-grade neoplasm demonstrating altered natural history and progressing more quickly to become life threatening in the setting of immunosuppression is theoretically increased, but the magnitude of this risk is unknown. With the increasing availability of targeted therapies with relatively favorable safety profiles prolonging survival in these patients, the unique possibility of entering into an allogeneic HSCT for a high-risk hematologic malignancy while planning post-transplant targeted therapy for the low-grade neoplasm emerges. However, the likelihood that a patient will be a suitable candidate for such effective, otherwise relatively non-toxic targeted therapy after what can be a very complicated course post transplant is impossible to determine a priori.

We have recently encountered this situation with a previously healthy 38-year-old man who presented with fatigue, easy bruising and nausea. Complete blood count revealed a hemoglobin of 8.3 g/dL, platelet count of 22 000 × 109/L and a leukocyte count of 157 000 × 109/L with 77% circulating blasts. A diagnosis of pre-B-cell ALL was made based on BM biopsy demonstrating near 100% cellularity with >90% blasts, expressing CD19, cytoplasmic CD22, nuclear TdT (dim), CD15, CD34 and HLA-DR. Cytogenetics revealed 14 out of 20 metaphases with a translocation (4;11)(q21;q23), and 9 of these had an additional X chromosome. Fluorescence in-situ hybridization studies on the BM specimen confirmed that 94.2% of nuclei had AF4/MLL fusion.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA

    S G Holtan, S R Palmer & W J Hogan

  2. Department of Oncology, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA

    S R Palmer & S H Okuno

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  1. S G Holtan
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  2. S R Palmer
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  3. S H Okuno
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  4. W J Hogan
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Correspondence to W J Hogan.

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Holtan, S., Palmer, S., Okuno, S. et al. Graft vs GIST?. Bone Marrow Transplant 47, 1246–1247 (2012). https://doi.org/10.1038/bmt.2011.247

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