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Cord blood donor cell leukemia in recipients

Leukemia volume 20, pages 1633–1634 (2006)Cite this article

Ando et al.1 report a case of acute myeloid leukaemia (AML) of donor cell origin following cord blood transplantation. This is the third such recent case.2, 3 At least two other cases, in Japan and France (S Mizutani and E Gluckman, personal communication), have been observed but as yet unpublished. A similar phenomenon has been recorded previously in more than 20 cases following conventional bone marrow transplantation.4 In both situations, leukemia of donor cell origin will be underestimated, but it appears that this event may be substantially more frequent with a cord blood source of stem cells. There are several potential explanations for leukemogenesis via this unusual route.1, 2, 3, 4 Perhaps, the most plausible was predicted for cord blood before the recent series of case reports.5, 6 Systematic screening of a large series of unselected cord blood samples revealed that ∼1% harboured putative pre-leukaemic clones with TEL-AML1 fusion or ∼0.2% with AML-ETO.5 The frequency of such cells in positive cord bloods was of the order of 10−3–10−4, indicative of a clone size of ∼106 cells in the new born. It was suggested that the clinical use of such ‘pre-leukaemic’ samples as a source of stem cells might involve a risk of leukaemia in association with the proliferative stress consequent to transplantation.5

Several inferences can be drawn from the data. First, if results with these particular fusion genes are typical of prenatal leukemia initiation in general,7 then something like 5% of cord bloods may contain pre-leukemic clones. Second, the risk of the cord blood donor with such clones developing leukaemia him or herself is very low and of the order of 1%.

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References

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  1. Chester Beatty Laboratories, Section of Haemato-Oncology, The Institute of Cancer Research, London, UK

    M F Greaves

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Greaves, M. Cord blood donor cell leukemia in recipients. Leukemia 20, 1633–1634 (2006). https://doi.org/10.1038/sj.leu.2404293

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