A 54-year-old RhD-negative male with del(20q)-positive myelodysplastic syndrome was transplanted with bone marrow from an HLA-identical RhD-positive sibling donor. Cytogenetic relapse was detected 21 months after stem cell transplantation (SCT), with reappearance of the original del(20q)-positive clone and reversion to recipient RhD-negative blood group. The patient received sequential donor lymphocyte infusions (DLIs), resulting in mild graft-versus-host disease and pure red cell aplasia. At 2 years post DLI, the patient remains in a stable condition, despite a dominance of recipient-derived erythro- and granulopoiesis originating in del(20q)-carrying progenitor cells. We conclude that reappearance of autologous erythropoiesis, upon relapse after allogeneic SCT, may be predictive of erythropenia after DLI and that re-emerging autologous del(20q)-positive erythropoiesis post DLI can provide a normal peripheral red blood cell count. Furthermore, in patients relapsing after blood-group-mismatched transplantation, a possible reversion to recipient blood group should be considered prior to blood transfusion or DLI.
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We thank Bodil Strömbeck (Department of Clinical Genetics in Lund) for her technical assistance in FISH analyses, as well as Anna Fossum and Dr Zhi Ma (Department of Stem Cell Biology in Lund) for their assistance in cell sorting. We also thank the Swedish Cancer Society, the Swedish Research Council, the Medical Faculty at Lund University and the Lund University Hospital Donation Funds for financial support of this study.
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Dykes, J., Lindmark, A., Lenhoff, S. et al. Autologous del(20q)-positive erythroid progenitor cells, re-emerging after DLI treatment of an MDS patient relapsing after allo-SCT, can provide a normal peripheral red blood cell count. Bone Marrow Transplant 33, 559–563 (2004). https://doi.org/10.1038/sj.bmt.1704383
- red blood cells
- blood group
- 20q deletion
- myelodysplastic syndrome
- allogeneic stem cell transplantation
- donor lymphocyte infusion
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