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Donor cell-derived myelodysplastic syndrome in a patient 7 years after unrelated allogeneic HLA-mismatched transplantation for Ph+ chronic myeloid leukemia

Bone Marrow Transplantation volume 36, page 737 (2005)Cite this article

Secondary malignancies after allogeneic stem cell transplantation are a known risk for stem cell recipients. The categories of new malignancies after transplant comprise lymphoproliferative disorders, hematologic malignancies (primarily therapy-related myelodysplastic syndrome and acute myeloid leukemia), and solid tumors. Some reviews summarize incidence and risk factors for these events.1, 2 In contrast, malignant diseases arising from donor-derived cells are exceptionally rare (see below). We report a patient developing donor-derived myelodysplastic syndrome (MDS) almost 7 years after allogeneic transplantation for Ph+ chronic myeloid leukemia (CML) in 1998.

This female patient was diagnosed with CML in 1996 at the age of 35 years. After cytoreductive therapy with hydroxyurea and subsequent therapy with interferon alpha, the patient developed blast crisis and was treated with TAD induction therapy resulting in a second chronic phase. Allogeneic bone marrow transplantation (BMT) with an HLA-DRB1-mismatched female unrelated donor was performed in July 1998 in our center. Myeloablative conditioning consisted of busulfan and cyclophosphamide. For GvH-prophylaxis we used cyclosporine, short-course MTX, mycophenolate mofetil, and prednisolone. There were no significant complications in the immediate post-transplant period except CMV reactivation, which was controlled. There were no signs of acute GvHD. In 1999, the patient developed limited chronic GvHD (hepatic) which progressed to extensive chronic GvHD (cutaneous, conjunctival, oral, hepatic). Further complications were recurring CMV reactivation, esophagitis and esophageal stenosis, and allergies to several antibiotics (vancomycin, clindamycin, penicillin). In March 2004, corneal transplantation was performed. The quality of life was impaired because of extensive chronic GvHD (especially skin and oral mucosa).

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Authors and Affiliations

  1. Klinik für Knochenmarktransplantation und Hämatologie/Onkologie, Idar-Oberstein, Germany

    L Kraut & A A Fauser

  2. Institut für Immunologie und Genetik, Kaiserslautern, Germany

    G Trebeljahr & B Thiele

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  1. L Kraut
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  2. G Trebeljahr
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  4. A A Fauser
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Kraut, L., Trebeljahr, G., Thiele, B. et al. Donor cell-derived myelodysplastic syndrome in a patient 7 years after unrelated allogeneic HLA-mismatched transplantation for Ph+ chronic myeloid leukemia. Bone Marrow Transplant 36, 737 (2005). https://doi.org/10.1038/sj.bmt.1705125

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