Donor cell-derived acute myeloid leukemia developing 14 months after matched unrelated bone marrow transplantation for chronic myeloid leukemia.
We report a patient with Ph-positive CML who developed a Ph-negative AML in donor cells 14 months after BMT from an HLA-identical male unrelated donor. The Ph translocation could not be detected by either conventional cytogenetics, FISH or RT-PCR analysis excluding relapse of CML in myeloid blast crisis. Chimerism studies were performed by variable number of tandem repeats (VNTR) analysis. These revealed donor-type hematopoiesis in both unseparated mononuclear cells and CD34+ selected blasts proving the leukemia to be of donor origin. The patient received three cycles of polychemotherapy with mitoxantrone, topotecan and ara-c resulting in CR after the first treatment cycle and reconstitution with donor hematopoiesis. A second transplant from a female alternative matched unrelated donor was performed after conditioning with fludarabine and 200 cGy TBI and was well tolerated. Nine months after the second transplant the patient is at home and in CR. T cell chimerism was studied by sex chromosome analysis and revealed complete female donor chimerism.
Hambach
L
L
Department of Hematology and Oncology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Eder
M
M
Dammann
E
E
Battmer
K
K
Stucki
A
A
Heil
G
G
Ganser
A
A
Hertenstein
B
B
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D016572:Cyclosporine / Q000627:therapeutic use; D003556:Cystitis / Q000188:drug therapy / Q000209:etiology; D003561:Cytarabine / Q000008:administration & dosage; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology; D004273:DNA, Neoplasm / Q000235:genetics; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006648:Histocompatibility; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016898:Interferon-alpha / Q000008:administration & dosage; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy / Q000628:therapy*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics / Q000628:therapy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008942:Mitoxantrone / Q000008:administration & dosage; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics / Q000628:therapy; D011239:Prednisolone / Q000627:therapeutic use; D011453:Prostaglandins / Q000627:therapeutic use; D012074:Remission Induction; D019772:Topotecan / Q000008:administration & dosage; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000494:pharmacology; D014916:Whole-Body Irradiation
D000998:Antiviral Agents; D004273:DNA, Neoplasm; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D011453:Prostaglandins; D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D017245:Foscarnet; D019772:Topotecan; D016572:Cyclosporine; D011239:Prednisolone; D008942:Mitoxantrone; D014740:Vidarabine; C024352:fludarabine; D015774:Ganciclovir; D006918:Hydroxyurea; D008727:Methotrexate