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Myelofibrosis as the initial presentation of donor-derived myelodysplastic syndrome/AML: failure of a lasting response to a second allogeneic transplant from the original donor

Bone Marrow Transplantation volume 42, pages 631–633 (2008)Cite this article

Donor-derived AML following allogeneic transplantation is a rare but well documented late complication of allogeneic transplantation.1, 2 Cases may present as frank leukaemia or with an antecedent history of myelodysplastic syndrome, and case studies have been published after BM, peripheral blood progenitor cell3 and umbilical SCT.4 However, initial presentation with myelofibrosis has not been previously reported.

A 36-year-old woman of Indian Asian ethnic origin presented with Philadelphia-positive CML (chronic phase) in 1994. She was treated with interferon-α before proceeding to an allogeneic BMT in 1996 from her HLA-matched sister. The conditioning regimen was CY (120 mg/kg) and TBI (14.4 Gy; total dose given over 4 days). Post-transplant complications included acute (grade II) GVHD progressing to chronic GVHD with extensive sclerodermatous changes (including oral involvement) and partial alopecia. Following the development of CYA-associated microangiopathy, this drug was stopped on day +56. Prednisolone, commenced initially as treatment for aGVHD, was continued and attempts to control the chronic GVHD with azathioprine, mycophenolate mofetil and CYA met with limited success. Control was eventually obtained with a combination of azathioprine (up to 100 mg b.i.d), prednisolone (up to 60 mg daily) and extracorporeal photopheresis, with the severity of the chronic GVHD necessitating the maintenance immunosuppression with azathioprine.

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Acknowledgements

We thank Professor HJ Deeg, Fred Hutchinson Cancer Centre, Seattle for his helpful discussions regarding this patient.

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Authors and Affiliations

  1. Department of Haematology, Royal Hallamshire Hospital, Sheffield, UK

    R J Cutting, E Welch, Y Ezaydi, J T Reilly & J A Snowden

  2. Department of Pathology, Royal Hallamshire Hospital, Sheffield, UK

    J Channer

  3. Department of Cytogenetics, Sheffield Children's Hospital NHS Foundation Trust, UK

    P Talley

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  1. R J Cutting
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  2. E Welch
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Correspondence to R J Cutting.

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Cutting, R., Welch, E., Channer, J. et al. Myelofibrosis as the initial presentation of donor-derived myelodysplastic syndrome/AML: failure of a lasting response to a second allogeneic transplant from the original donor. Bone Marrow Transplant 42, 631–633 (2008). https://doi.org/10.1038/bmt.2008.224

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