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Development of BCR-ABL positive acute lymphoblastic leukemia in donor cells after allogeneic hematopoietic cell transplantation for Philadelphia-positive acute lymphoblastic leukemia

Bone Marrow Transplantation volume 34, pages 189–191 (2004)Cite this article

The most frequent cause of treatment failure after allogeneic hematopoietic cell transplantation (allo-HCT) for leukemia is relapse of the underlying host leukemia. However, occasionally, cytogenetic analysis, alone or in combination with molecular analysis, has indicated that the new leukemia originated in donor cells (DC).1 Leukemic transformation of DC was first described in 1971; 19 further cases have been reported since, of which 13 were acute lymphoblastic leukemia (ALL).1, 2, 3

We report the first case of DC BCR-ABL(+) ALL developing after allo-HCT for Ph(+) ALL. A 37-year-old female was diagnosed with common-ALL (CD10+CD19+CD20+CD22+CD34+CD38+TdT+CD13+MPO−) in November 2001; she had hyperdiploid karyotype with trisomies of chromosomes 2,6,8, and t(9;22) and carried BCR-ABL (e1a2) transcripts. The patient attained complete hematological and cytogenetic remission after one course of the HyperCVAD regimen and was consolidated with one course each of adriamycin–vincristine–high dose cytarabine–prednisone and BiCNU–etoposide–cyclophosphamide–prednisone. She was referred to our Department with the prospect of allo-HCT; then she was tested negative for either BCR-ABL chimeric transcripts or clonal immunoglobulin heavy-chain gene (IgH) rearrangements. In March 2002, after BuCy conditioning she received peripheral blood stem cells (6.32 × 106 CD34+cells/kg) from an HLA-identical male sibling donor. Cyclosporin A and methotrexate were given for GVHD prophylaxis. Molecular remission was maintained in a setting of extensive chronic GVHD until 6 months post-transplant; 4 months later, the patient had overt relapse with CD10+CD19+TdT+MPO−ALL. She attained complete hematological/molecular remission after one course of the C-VAD regimen. Six months after relapse, she maintains complete donor chimerism (CDC) and is scheduled for a second allo-HCT from another HLA-matched sibling.

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  1. Hematology Department and BMT Unit, G Papanicolaou Hospital, Thessaloniki, 57010, Greece

    A Athanasiadou, K Stamatopoulos, I Sakellari, I Zorbas, M Gaitatzi, A Fassas & A Anagnostopoulos

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  1. A Athanasiadou
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  2. K Stamatopoulos
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  3. I Sakellari
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  7. A Anagnostopoulos
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Athanasiadou, A., Stamatopoulos, K., Sakellari, I. et al. Development of BCR-ABL positive acute lymphoblastic leukemia in donor cells after allogeneic hematopoietic cell transplantation for Philadelphia-positive acute lymphoblastic leukemia. Bone Marrow Transplant 34, 189–191 (2004). https://doi.org/10.1038/sj.bmt.1704554

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