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Clonally identical Hodgkin's disease develops after allogeneic hematopoietic cell transplant for CLL

Bone Marrow Transplantation volume 46, pages 1576–1578 (2011)Cite this article

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We present a patient with CLL who achieved remission following allogeneic BMT and donor lymphocyte infusion, but 1.5 years later developed clonally identical Hodgkin's disease.

Five years after diagnosis, she underwent reduced intensity conditioning with TLI and anti-thymoglobulin, followed by allogeneic hematopoietic cell transplant (allo-HCT) from an unrelated 21-year-old female 10/10 HLA-identical donor.1 Four doses of rituximab (anti-CD20) followed at 56–77 days after HCT on a GVHD prevention protocol. By 90 days after transplant, she achieved 100% donor CD3 T-cell chimerism (blue; Figure 1g) and CD19 B-cell chimerism. She obtained molecular remission with no detectable CLL by allele-specific quantitative PCR assay (VH IgG assay (red)). Her CD56 NK cell and CD15 myeloid chimerism remained mixed, with a maximum donor contribution of 90% (black) and 76%, respectively. CLL was redetected by allele-specific quantitative PCR 180 days post-HCT. New hypermetabolic lymph nodes were detected by PET-CT scan (Figure 1h). Figure 1g shows CLL expansion as donor CD3 T cell and CD56 NK-cell chimerism fell to 30% off immune-suppressive medications. Unmanipulated donor lymphocyte infusion dosed 3 × 107 CD3 cells/kg at 270 days post-transplant converted her to full donor T- and NK-cell chimerism. By 90 days after donor lymphocyte infusion, she reachieved CR by allele-specific quantitative PCR and PET-CT scan (Figures 1g and i). She concurrently developed skin and liver GVHD, which was effectively treated with 1 mg/kg prednisone.

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Acknowledgements

We thank our patient and her family. We also thank Peter Maxim, PhD, from the Stanford University Department of Radiation Oncology for helping us acquire the PET-CT images, and Matt Inlay, PhD, from Irving Weissman's laboratory at Stanford University for reviewing the manuscript. This research was supported by Leukemia and Lymphoma Society Translational Research Grant 6204-06 and NCI P01 CA049605.

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Authors and Affiliations

  1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA

    D Tseng

  2. Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA

    C D Jones, M Anderson, R Warnke & J L Zehnder

  3. Department of Medicine, Division of Bone Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA

    D B Miklos

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  1. D Tseng
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Correspondence to D B Miklos.

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Tseng, D., Jones, C., Anderson, M. et al. Clonally identical Hodgkin's disease develops after allogeneic hematopoietic cell transplant for CLL. Bone Marrow Transplant 46, 1576–1578 (2011). https://doi.org/10.1038/bmt.2010.340

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