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Therapy-related, donor-derived AML responding to a second allogeneic BMT

Bone Marrow Transplantation volume 40, pages 499–500 (2007)Cite this article

Donor cell leukemia is a rare complication of allogeneic BMT, and many hypotheses about the underlying mechanisms have been put forth.1, 2 Since donor cell leukemia is such a rare phenomenon, treatment of these patients has not been standardized. In this report, we present a child with pre-B ALL who developed a secondary AML of donor origin with Mixed-lineage leukemia (MLL) gene rearrangement after treatment for a relapse of his ALL after allogeneic BMT. A second allogeneic BMT with marrow from the same donor was performed and the patient is in ongoing complete remission now for 4 years. Our data show that long-lasting remission can be achieved after donor-derived, therapy-related AML by a second transplant with marrow from the same donor.

One-and-a-half years after the third relapse, 4 years after the BMT, the patient developed an AML (Figure 1b). Flow cytometric analysis revealed that the blasts were positive for CD33, CD34, CD13, CD45, CD117 and HLA-DR. Karyotyping of the leukemic blasts showed a t(9;11)(p22;q23) translocation in all analyzed cells. Subsequent FISH analysis revealed that this translocation caused a disruption of the MLL gene (Figure 1c). Quantitative assessment of hematopoietic chimerism using polymorphism RT-PCR3 demonstrated complete donor chimerism of both peripheral blood and bone marrow at the time of AML diagnosis (data not shown). This demonstrates that the secondary AML is of donor origin.

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Authors and Affiliations

  1. Department of Pediatric Hemato-oncology, Radboud University Medical Center, Nijmegen, The Netherlands

    J F M Jacobs, P P Brons & P M Hoogerbrugge

  2. Department of Antropogenetics, Radboud University Medical Center, Nijmegen, The Netherlands

    A Simons

  3. Department of Central Hematology Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands

    B A van der Reijden

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  1. J F M Jacobs
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Correspondence to J F M Jacobs.

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Jacobs, J., Brons, P., Simons, A. et al. Therapy-related, donor-derived AML responding to a second allogeneic BMT. Bone Marrow Transplant 40, 499–500 (2007). https://doi.org/10.1038/sj.bmt.1705750

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