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Hoshino T, Hatsumi N, Iino H, Takada S. Therapy-related myeloid neoplasms of recipient origin after allogeneic hematopoietic stem cell transplantation for acute leukemia. Int J Hematol 2022; 116:902-910. [DOI: 10.1007/s12185-022-03442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/20/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
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2
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Kuno M, Yamasaki S, Fujii N, Ishida Y, Fukuda T, Kataoka K, Uchida N, Katayama Y, Sato M, Onai D, Miyamoto T, Ota S, Yoshioka S, Ara T, Hangaishi A, Hashii Y, Onizuka M, Ichinohe T, Atsuta Y, Inamoto Y. Characterization of myeloid neoplasms following allogeneic hematopoietic cell transplantation. Am J Hematol 2022; 97:185-193. [PMID: 34738245 DOI: 10.1002/ajh.26401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
We compared characteristics of myeloid neoplasms (MNs) following allogeneic hematopoietic cell transplantation (HCT) versus autologous HCT using a Japanese HCT registry database. Among 43 788 patients who underwent allogeneic (n = 18 874) or autologous HCT (n = 24 914) for non-myeloid malignancies or non-malignant diseases, 352 developed MNs. The cumulative incidence of MNs was lower after allogeneic HCT than after autologous HCT (0.3% vs. 1.8% at 10 years, respectively, p < .001). Compared with autologous HCT, MNs following allogeneic HCT developed in younger patients (median, 42 vs. 57 years old, respectively) and sooner after HCT (median, 16 vs. 33 months, respectively). Approximately half of MNs following allogeneic HCT were donor-derived and occurred later than recipient-derived MNs (median, 26 vs. 6 months, respectively, p = .003). In multivariate analysis, reduced-intensity conditioning and cord blood transplantation were associated with MN development after allogeneic HCT. Overall survival was similar in patients who developed MNs following allogeneic versus autologous HCT (18% vs. 22% at 5 years, respectively, p = .48). Patient age ≥ 55 years, the presence of previous HCT, AML subtype, and chromosome 5 or 7 abnormalities were adverse factors for overall survival after MN diagnosis. Further research is warranted to elucidate the mechanisms of MN development following allogeneic HCT.
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Affiliation(s)
- Masatomo Kuno
- Department of Hematology, Graduate School of Medicine Osaka City University Osaka Japan
| | - Satoshi Yamasaki
- Department of Internal Medicine Kyushu University Beppu Hospital Beppu Japan
| | - Nobuharu Fujii
- Division of Blood Transfusion Okayama University Hospital Okayama Japan
| | - Yasushi Ishida
- Pediatric Medical Center Ehime Prefectural Central Hospital Ehime Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan
| | - Keisuke Kataoka
- Division of Hematology, Department of Medicine Keio University School of Medicine Tokyo Japan
- Division of Molecular Oncology National Cancer Center Research Institute Tokyo Japan
| | | | - Yuta Katayama
- Department of Hematology Hiroshima Red Cross Hospital & Atomic‐bomb Survivors Hospital Hiroshima Japan
| | - Maho Sato
- Department of Hematology/Oncology Osaka Women's and Children's Hospital Osaka Japan
| | - Daishi Onai
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science Kyushu University Graduate School of Medical Sciences Fukuoka Japan
| | - Shuichi Ota
- Department of Hematology Sapporo Hokuyu Hospital Hokkaido Japan
| | - Satoshi Yoshioka
- Department of Hematology Kobe City Medical Center General Hospital Hyogo Japan
| | - Takahide Ara
- Department of Hematology Hokkaido University Hospital Hokkaido Japan
| | - Akira Hangaishi
- Department of Hematology National Center for Global Health and Medicine Tokyo Japan
| | - Yoshiko Hashii
- Department of Pediatrics Osaka International Cancer Institute Osaka Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology Tokai University School of Medicine Kanagawa Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine Hiroshima University Hiroshima Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation Aichi Japan
- Department of Registry Science for Transplant and Cellular Therapy Aichi Medical University School of Medicine Aichi Japan
| | - Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation National Cancer Center Hospital Tokyo Japan
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Wang E, Hutchinson CB, Huang Q, Lu CM, Crow J, Wang FF, Sebastian S, Rehder C, Lagoo A, Horwitz M, Rizzieri D, Yu J, Goodman B, Datto M, Buckley P. Donor cell-derived leukemias/myelodysplastic neoplasms in allogeneic hematopoietic stem cell transplant recipients: a clinicopathologic study of 10 cases and a comprehensive review of the literature. Am J Clin Pathol 2011; 135:525-40. [PMID: 21411775 DOI: 10.1309/ajcppjuq9dnr1ghp] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We report 10 cases of donor cell leukemia (DCL). All cases except the case of chronic lymphocytic leukemia had anemia, neutropenia, and/or thrombocytopenia when DCL was diagnosed. Eight cases with sex-mismatched hematopoietic stem cell transplant (HCT) showed donor gonosomal complements, suggesting DCL. Clonal cytogenetic abnormalities were detected in 8 cases: 6 were monosomy 7/del(7q). In all 10 cases, engraftment studies confirmed donor cell origin. Retrospective fluorescence in situ hybridization in archived donor cells in 4 cases showed a low level of abnormalities in 2. Of 7 patients with clinical follow-up of 5 months or more, 1 (with acute myeloid leukemia) died of disease; 6 are alive, including 1 with myelodysplastic syndrome with spontaneous remission. Similar to reported cases, we found disproportional sex-mismatched HCTs, suggesting probable underdetection of DCL in sex-matched HCTs. The latency between HCT and DCL ranged from 1 to 193 months (median, 24 months), in keeping with the literature. Analyzing our cases, pooled with reported cases, with survival models showed much shorter latency for malignancy as primary disease, for T-cell large granular lymphocyte leukemia as type of DCL, and for umbilical cord blood as stem cell source.
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Yabe M, Morimoto T, Shimizu T, Koike T, Takakura H, Arakawa S, Kato S, Yabe H. Therapy-related myelodysplastic syndrome of recipient origin in a juvenile myelomonocytic leukemia patient 17 years after allogeneic BMT. Bone Marrow Transplant 2010; 46:1023-5. [PMID: 20871639 DOI: 10.1038/bmt.2010.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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5
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Roos-Weil D, Nguyen S, Uzunov M, Bories D, Chapiro E, Nguyen-Khac F, Vernant JP, Dhédin N. Therapy-related myelodysplastic syndrome after allogeneic BMT: successful treatment by donor lymphocyte infusions. Bone Marrow Transplant 2010; 45:1471-3. [DOI: 10.1038/bmt.2009.369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Yamamoto K, Yakushijin K, Kawamori Y, Minagawa K, Katayama Y, Matsui T. Translocation (7;9)(q22;q34) in therapy-related myelodysplastic syndrome after allogeneic bone marrow transplantation for acute myeloblastic leukemia. ACTA ACUST UNITED AC 2007; 176:61-6. [PMID: 17574966 DOI: 10.1016/j.cancergencyto.2007.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 02/07/2007] [Accepted: 02/09/2007] [Indexed: 11/26/2022]
Abstract
Reciprocal translocations involving the long arm of chromosome 7 are relatively rare cytogenetic aberrations in myelodysplastic syndrome (MDS) and acute myeloblastic leukemia (AML). A 44-year-old woman was initially given a diagnosis of de novo AML M6A with a normal karyotype. After achieving complete remission, she received allogeneic bone marrow transplantation from an unrelated male donor. Seven months later, pancytopenia appeared with 14.8% myeloblasts and dysplastic changes of neutrophils and megakaryocytes in the bone marrow. Chromosome analysis revealed complex karyotypes, with add(7)(q22) and add(9)(q34) detected in all abnormal metaphase spreads; spectral karyotyping revealed these chromosomal aberrations to be derived from a reciprocal translocation t(7;9)(q22;q34). Fluorescence in situ hybridization analyses showed that D7S486 at 7q31 was translocated to the der(9)t(7;9), and that the ABL gene at 9q34 remained on the der(9)t(7;9). Because the same translocation reappeared and sustained for more than 8 months after second stem cell transplantation, we revised the diagnosis as therapy-related MDS after allogeneic transplantation. The t(7;9)(q22;q34) was supposed to have a crucial role in the pathogenesis of MDS. Considering two other such reported cases of AML, the t(7;9)(q22;q34) may be a novel recurrent translocation in myeloid malignancies.
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Affiliation(s)
- Katsuya Yamamoto
- Hematology/Oncology, Department of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Au WY, Pang A, Lam KKY, Song YQ, Lee WM, So JCC, Kwong YL. G6PD deficiency from lyonization after hematopoietic stem cell transplantation from female heterozygous donors. Bone Marrow Transplant 2007; 40:677-81. [PMID: 17660836 DOI: 10.1038/sj.bmt.1705796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To determine whether during hematopoietic stem cell transplantation (HSCT), X-chromosome inactivation (lyonization) of donor HSC might change after engraftment in recipients, the glucose-6-phosphate dehydrogenase (G6PD) gene of 180 female donors was genotyped by PCR/allele-specific primer extension, and MALDI-TOF mass spectrometry/Sequenom MassARRAY analysis. X-inactivation was determined by semiquantitative PCR for the HUMARA gene before/after HpaII digestion. X-inactivation was preserved in most cases post-HSCT, although altered skewing of lyonization might occur to either of the X-chromosomes. Among pre-HSCT clinicopathologic parameters analyzed, only recipient gender significantly affected skewing. Seven donors with normal G6PD biochemically but heterozygous for G6PD mutants were identified. Owing to lyonization changes, some donor-recipient pairs showed significantly different G6PD levels. In one donor-recipient pair, extreme lyonization affecting the wild-type G6PD allele occurred, causing biochemical G6PD deficiency in the recipient. In HSCT from asymptomatic female donors heterozygous for X-linked recessive disorders, altered lyonization might cause clinical diseases in the recipients.
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Affiliation(s)
- W-Y Au
- Department of Medicine, University of Hong Kong, Hong Kong, China
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Au WY, Fung A, Lam KY, Lie AK, Liang R, Kwong YL. Transformed essential thrombocytosis with a JAK2 V617F mutation relapsing as JAK2 mutation-negative leukaemia after allogeneic stem cell transplantation. Bone Marrow Transplant 2006; 38:573-4. [PMID: 16953212 DOI: 10.1038/sj.bmt.1705482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Reichard KK, Zhang QY, Sanchez L, Hozier J, Viswanatha D, Foucar K. Acute myeloid leukemia of donor origin after allogeneic bone marrow transplantation for precursor T-cell acute lymphoblastic leukemia: case report and review of the literature. Am J Hematol 2006; 81:178-85. [PMID: 16493618 DOI: 10.1002/ajh.20389] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of donor-derived acute myeloid leukemia (AML) occurring in a 33-year-old man after allogeneic bone marrow transplantation (BMT) for precursor T-cell acute lymphoblastic -leukemia (T-ALL). The cells for BMT were from his human leukocyte antigen (HLA)-matched sister. Fluorescence in-situ hybridization (FISH) analysis showed the AML to be of donor origin (i.e., karyotypically female) with an 11q23 (mixed lineage leukemia (MLL) gene) translocation, while the original T-ALL exhibited a male karyotype with abnormalities of chromosomes 6, 8, and a t(10;14)(q24;q11.2). Subsequent molecular short tandem repeat studies confirmed the AML to be of donor origin. Donor-cell leukemia (DCL) after allogeneic BMT is a rare, yet well-documented, event. Our report presents clinicopathologic information about a case of DCL and a review of the recent literature.
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MESH Headings
- Adult
- Bone Marrow Transplantation
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping
- Leukemia, Myeloid, Acute/etiology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Living Donors
- Male
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/complications
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Precursor T-Cell Lymphoblastic Leukemia-Lymphoma/therapy
- Transplantation Chimera
- Transplantation, Homologous
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Affiliation(s)
- Kaaren K Reichard
- Department of Pathology, University of New Mexico, Albuquerque, 87131, USA.
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Au WY, Lie AKW, Ma ESK, Lau GKK, Chan EC, Kwong YL. Late-onset pure red blood cell aplasia owing to delayed lymphoid engraftment complicating ABO-mismatched hematopoietic stem cell transplantation. Transfusion 2004; 44:946-7. [PMID: 15157268 DOI: 10.1111/j.1537-2995.2004.00377.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
MESH Headings
- Adult
- Blood Group Incompatibility/complications
- Bone Marrow Transplantation/adverse effects
- Female
- Graft Survival
- Hematopoiesis
- Hepatitis B, Chronic/complications
- Hepatitis B, Chronic/immunology
- Histocompatibility
- Humans
- Immunocompromised Host
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocytes/cytology
- Neoplasm, Residual
- Red-Cell Aplasia, Pure/etiology
- Time Factors
- Transplantation Chimera/blood
- Transplantation, Homologous/adverse effects
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11
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Au WY, Ma SK, Kwong YL. The occurrence of Philadelphia chromosome (Ph) negative leukemia after hematopoietic stem cell transplantation for Ph positive chronic myeloid leukemia: implications for disease monitoring and treatment. Leuk Lymphoma 2003; 44:1121-9. [PMID: 12916863 DOI: 10.1080/1042819031000079104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic myeloid leukemia (CML) is a clonal neoplastic disorder, characterized by t(9;22)(q34;q11) that results in the formation of the Philadelphia chromosome (Ph) and the BCR/ABL fusion gene. Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for CML. Much of its therapeutic efficacy is attributed to a graft-versus-leukemia (GVL) effect exerted by donor-derived lymphoid cells against the Ph positive (Ph+) clone. Post-HSCT monitoring by cytogenetic and molecular detection of the Ph+ clone is necessary, so that pre-emptive immunologic or pharmacologic treatment may be administered at an early stage of relapse. However, under rare circumstances a second Ph negative (Ph-) leukemia may evolve post-HSCT. The pathogenetic possibilities included leukemia arising from donor-derived hematopoietic stem cells (HSCs), or transformation of residual recipient-derived Ph- HSCs that have survived the conditioning chemotherapy and radiotherapy. Recipient-derived Ph- leukemia may be related to genetic alterations that precede the onset of CML, or myelotoxic effects of the HSCT conditioning regimen. The diagnosis of Ph- relapses requires detailed investigations by conventional karyotyping, fluorescence in-situ hybridization (FISH), and molecular analysis; as well as chimerism studies that help to document the donor or recipient origin of the leukemia. Although uncommonly reported in the past, Ph- relapses may in fact be more frequent if leukemic relapses post-HSCT are more thoroughly evaluated with these investigations. The recognition of Ph- relapses are important in several ways. Ph- relapses cannot be identified by monitoring investigations targeting the Ph+ clone, so that the early detection of Ph- leukemia is usually not possible. Furthermore, Ph- relapses will not respond to therapeutic strategies effective against the Ph+ CML clone.
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MESH Headings
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Leukemia, Myeloid, Chronic, Atypical, BCR-ABL Negative/etiology
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Affiliation(s)
- W Y Au
- University Department of Medicine, Queen Mary Hospital, Hong Kong, People's Republic of China
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12
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Au WY, Fung A, Man C, Ma SK, Wan TS, Liang R, Kwong YL. Aberrant p15 gene promoter methylation in therapy-related myelodysplastic syndrome and acute myeloid leukaemia: clinicopathological and karyotypic associations. Br J Haematol 2003; 120:1062-5. [PMID: 12648079 DOI: 10.1046/j.1365-2141.2003.04194.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seventeen patients with therapy-related myelodysplastic syndrome/acute myeloid leukaemia (t-MDS/AML) were examined for aberrant p15 gene methylation by methylation-specific polymerase chain reaction. Ten patients (58%) showed p15 methylation, which was significantly related to monosomy/deletion of chromosome 7q, but not to antecedent chemotherapy, blast count, leukaemic evolution or survival. In three of six patients with marrow samples obtained prior to the diagnosis of t-MDS/AML, p15 methylation predated disease development by up to 2 years. Bone marrow transplantation led to the disappearance of p15 methylation in one patient. These results showed that p15 methylation was an early event in the evolution of some t-MDS/AML patients.
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Affiliation(s)
- W Y Au
- University Department of Medicine, Queen Mary Hospital, Hong Kong
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13
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Au WY, Chan EC, Siu LLP, Lau TCM, Lie AKW, Ma SK, Kwong YL. Leukaemic relapse of donor origin after allogeneic bone marrow transplantation from a donor who later developed bronchogenic carcinoma. Br J Haematol 2002; 119:777-80. [PMID: 12437659 DOI: 10.1046/j.1365-2141.2002.03925.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Donor-derived leukaemia is exceptional after allogeneic bone marrow transplantation (BMT). A woman with chronic myeloid leukaemia received an allogeneic BMT from a human leucocyte antigen-identical brother. The donor, a 50-year-old non-smoker, died of squamous cell bronchogenic carcinoma 1 year later. At 4 years post BMT, the patient became BCR/ABL positive and relapsed with acute myeloid leukaemia, which was shown to be donor-derived cytogenetically and molecularly. Retrospective analysis showed that the donor-leukaemic clone had started to evolve as early as 6 months post BMT. Sequencing of p53 ruled out Li-Fraumeni syndrome. Predisposition to malignancy might be an underlying mechanism of donor-cell leukaemia.
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Affiliation(s)
- W Y Au
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Au WY, Lie AKW, Ma SK, Wan TS, Liang R, Chan EC, Kwong YL. Tyrosine kinase inhibitor STI571 in the treatment of Philadelphia chromosome-positive leukaemia failing myeloablative stem cell transplantation. Bone Marrow Transplant 2002; 30:453-7. [PMID: 12368958 DOI: 10.1038/sj.bmt.1703678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2002] [Accepted: 07/08/2002] [Indexed: 11/09/2022]
Abstract
Eight patients with Philadelphia chromosome-positive (Ph(+)) leukaemia relapsing from stem cell transplantation (SCT) (one syngeneic and seven allogeneic) were treated with the tyrosine kinase inhibitor STI571. Five patients relapsing as chronic myeloid leukaemia (CML) in chronic phase achieved a complete haematological response, with complete and major cytogenetic responses occurring in four and one cases, respectively. One patient became negative for BCR/ABL in the bone marrow. Three patients relapsed as acute leukaemia (two CML in myeloblastic crisis and one Ph(+) acute lymphoblastic leukaemia), all of whom achieved haematological and cytogenetic responses. One patient also became BCR/ABL negative. However, pancytopenia and graft-versus-host disease led to cessation of treatment in the remaining two cases, which was followed by disease recurrence refractory to further STI treatment. Our results showed that Ph(+) leukaemic relapses after SCT might respond well to STI571 therapy.
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Affiliation(s)
- W Y Au
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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15
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Au WY, Lie AKW, Kwong YL, Shek TW, Hawkins BR, Lai KN, Tang SCW, Lo CM, Fan ST, Liu CL, Chan GCF, Chau EMC, Chiu SW, Liang R. Post-transplantation lymphoproliferative disease in Chinese: the Queen Mary Hospital experience in Hong Kong. Leuk Lymphoma 2002; 43:1403-7. [PMID: 12389620 DOI: 10.1080/10428190290033341] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Post-transplantation lymphoproliferative disease (PTLD) is an unique iatrogenic complication after bone marrow transplantation (BMT) and solid organ transplantation (SOTx). The pattern of EBV related lymphoma in Chinese is different from Caucasians. We surveyed the incidence, clinical and pathological spectrum of PTLD among 541 cases of allogeneic BMT, 145 cases of renal transplant, 35 cases of heart/lung transplantation and 146 cases of orthotopic liver transplantation (OLT). From 1994 to 2001, 13 consecutive cases of PTLD were diagnosed, ranging from disseminated NK cell lymphoma to localized plasmacytoma. Both donor and recipient derived PTLD was documented. Disease was often heralded by cytomegaloviral disease and antithymocyte globulin (ATG) usage. Two cases were diagnosed post-mortem, and six patients died of PTLD at a median of 3 months. Complete and partial remission was only achieved in 3 and 2 cases, respectively, despite a range of treatment (reduced immunosuppression, explantation, radiotherapy, combination chemotherapy, donor lymphocytes, autologous marrow infusion and rituximab). Most responding patients died subsequently of rejection, infection and graft versus host disease (GVHD). The incidence of PTLD is not increased in Chinese patients. However, some patients may be at increased risk, especially mismatched allogeneic BMT, parental OLT (especially involving young infants) and heavy ATG exposure.
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Affiliation(s)
- W Y Au
- The University Department of Medicine, Queen Mary Hospital, University of Hong Kong, Peoples' Republic of China.
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16
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Au WY, Ma SK, Lie AKW, Liang R, Cheng T, Kwong YL. Glucose-6-phosphate dehydrogenase deficiency and hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29:399-402. [PMID: 11919729 DOI: 10.1038/sj.bmt.1703369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2001] [Accepted: 12/03/2001] [Indexed: 11/09/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked hemolytic enzymopathy affecting 3% of Southern Chinese males. Among 275 adult allogeneic hematopoietic stem cell transplantations (SCT), five cases (1.8%) each of donors and recipients were G6PD deficient. Among 107 autologous SCT, four patients (3.7%) were G6PD deficient. All subjects were male, except for two female patients with chronic myeloid leukemia (CML). The incidence of G6PD deficiency in female CML patients was significantly higher than the background female incidence (P = 0.004), but comparable with that in the males (P = 0.664). There was no significant hemolysis or delay in red cell engraftment, and all but one patient converted to donor G6PD screening status. One female patient achieved partial correction of her G6PD status and relapsed at 10 months. We suggest that G6PD deficiency should be tested for in all marrow donors and recipients in susceptible populations. From our data, there is a suggestion of increased clinical incidence of G6PD deficiency in female patients with multi-lineage clonal marrow disorders.
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MESH Headings
- Adolescent
- Adult
- Anemia, Hemolytic/chemically induced
- Anemia, Hemolytic/enzymology
- Anemia, Hemolytic/prevention & control
- Anti-Infective Agents/adverse effects
- China/epidemiology
- Contraindications
- Female
- Glucosephosphate Dehydrogenase/blood
- Glucosephosphate Dehydrogenase Deficiency/complications
- Glucosephosphate Dehydrogenase Deficiency/diagnosis
- Glucosephosphate Dehydrogenase Deficiency/etiology
- Hematologic Diseases/complications
- Hematologic Diseases/enzymology
- Hematologic Diseases/therapy
- Humans
- Incidence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Male
- Mass Screening
- Middle Aged
- Myeloproliferative Disorders/enzymology
- Stem Cell Transplantation/adverse effects
- Stem Cell Transplantation/methods
- Tissue Donors
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Affiliation(s)
- W Y Au
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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17
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Au WY, Yeung CK, Chan HH, Lie AK. Generalized vitiligo after lymphocyte infusion for relapsed leukaemia. Br J Dermatol 2001; 145:1015-7. [PMID: 11899125 DOI: 10.1046/j.1365-2133.2001.04500.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vitiligo is an autoimmune disease caused by T-lymphocyte-mediated destruction of melanocytes. We describe two patients with generalized vitiligo caused iatrogenically after donor lymphocyte infusion (DLI) for leukaemia relapse over 3 years after bone marrow transplantation (BMT). Neither the sibling donor nor the recipient had vitiligo or other autoimmune diseases, and vitiligo did not occur after the first BMT. DLI was accompanied by skin graft-versus-host disease in both cases, which was controlled with immunosuppression. However, over several months, progressive generalized and persistent skin depigmentation occurred in both patients. Peripheral blood molecular studies showed the complete disappearance of host haematolymphopoiesis. The specific destruction of melanocytes in both patients was therefore probably mediated by new alloreactive lymphocytes infused from the donors.
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Affiliation(s)
- W Y Au
- Department of Medicine, Queen Mary Hospital, University of Hong Kong.
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Au WY, Lie AK, Ma SK, Wan TS, Liang R, Leung YH, Kwong YL. Philadelphia (Ph) chromosome-positive chronic myeloid leukaemia relapsing as Ph-negative leukaemia after allogeneic bone marrow transplantation. Br J Haematol 2001; 114:365-8. [PMID: 11529857 DOI: 10.1046/j.1365-2141.2001.02960.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two patients with Philadelphia chromosome-positive (Ph(+)) chronic myeloid leukaemia (CML) relapsed 1.5 and 5 years after allogeneic bone marrow transplantation (BMT). Although the leukaemias were of recipient origin, t(9;22) could no longer be detected using conventional cytogenetics/fluorescence in situ hybridization or molecularly. Both patients responded to immunotherapy with donor lymphocytes/peripheral blood stem cells, although one patient ultimately relapsed again. These patients were similar to the occurrence of Ph(-) leukaemias previously described in Ph(+) CML after treatment with interferon or autologous BMT, and might be relevant in the pathogenesis and monitoring of treatment after BMT in CML.
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MESH Headings
- Adult
- Blood Transfusion, Autologous
- Bone Marrow Transplantation
- Fusion Proteins, bcr-abl
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
- Lymphocyte Transfusion
- Male
- Philadelphia Chromosome
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Recurrence
- Reverse Transcriptase Polymerase Chain Reaction
- Transplantation, Homologous
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Affiliation(s)
- W Y Au
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong
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