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Transient chromosomal rearrangements in three children with acute lymphoblastic leukemia after unrelated cord blood transplantation

Bone Marrow Transplantation volume 46, pages 452–454 (2011)Cite this article

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SCT such as BMT or cord blood transplantation (CBT) is an effective therapy for hematological malignancies. Nevertheless, there are still serious problems associated with SCT, such as secondary malignancy and relapse. Both chemotherapy and radiation for conditioning regimen before SCT are thought to be causes of genomic instability. Occasionally, they produce different types of chromosomal aberrations, which may lead to the development of secondary malignancies. Transient (clonal or nonclonal) chromosomal abnormalities after SCT have been reported by some studies, mainly observed after BMT.1 Kim et al.1 described a first case with this rare event after CBT. Here, we report three cases of children with ALL who showed transient chromosomal rearrangements after unrelated CBT and discuss the possible causes and consequences of this phenomenon.

In 2008, three pediatric patients with ALL underwent unrelated CBT at our center. The clinical data of these patients and the case described by Kim et al.1 are shown in Table 1. All our patients are boys and underwent transplantation in second clinical remission. The conditioning regimen included fractionated TBI (12 Gy TBI by 6 days), cytarabine and ATG. After CBT, the cytogenetic analysis of BM cells showed the transient chromosomal rearrangements at different times of follow-up (Table 2). These rearrangements were transient (clonal and non-clonal) and involved different chromosome regions. In our patients, the transient chromosomal rearrangements were associated with delayed hematological recovery (case 2), primary rejection (case 3) and, mainly, autologous reconstitution without disease evidence or secondary malignancy (myelodysplastic syndrome). Nowadays, the molecular analysis by variable number tandem repeat showed that one patient has mixed chimerism (case 1) in BM sample and the other two have autologous recovery (cases 2 and 3). At the time of reporting these patients were hematologically normal (remission).

Table 1 Clinical data of the patients with transient chromosomal rearrangements after CBT
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Table 2 Cytogenetic results of the ALL children treated with cord blood transplantation
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  1. Bone Marrow Transplantation Center, National Cancer Institute (INCA), Rio de Janiero, Brazil

    L Otero, T de Souza Fernandez, T F Padilha, F N Carestiato, L F Bouzas & E Abdelhay

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  1. L Otero
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  2. T de Souza Fernandez
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Correspondence to L Otero.

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Otero, L., de Souza Fernandez, T., Padilha, T. et al. Transient chromosomal rearrangements in three children with acute lymphoblastic leukemia after unrelated cord blood transplantation. Bone Marrow Transplant 46, 452–454 (2011). https://doi.org/10.1038/bmt.2010.120

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