Autologous del(20q)-positive erythroid progenitor cells, re-emerging after DLI treatment of an MDS patient relapsing after allo-SCT, can provide a normal peripheral red blood cell count.
A 54-year-old RhD-negative male with del(20q)-positive myelodysplastic syndrome was transplanted with bone marrow from an HLA-identical RhD-positive sibling donor. Cytogenetic relapse was detected 21 months after stem cell transplantation (SCT), with reappearance of the original del(20q)-positive clone and reversion to recipient RhD-negative blood group. The patient received sequential donor lymphocyte infusions (DLIs), resulting in mild graft-versus-host disease and pure red cell aplasia. At 2 years post DLI, the patient remains in a stable condition, despite a dominance of recipient-derived erythro- and granulopoiesis originating in del(20q)-carrying progenitor cells. We conclude that reappearance of autologous erythropoiesis, upon relapse after allogeneic SCT, may be predictive of erythropenia after DLI and that re-emerging autologous del(20q)-positive erythropoiesis post DLI can provide a normal peripheral red blood cell count. Furthermore, in patients relapsing after blood-group-mismatched transplantation, a possible reversion to recipient blood group should be considered prior to blood transfusion or DLI.
Dykes
J H
JH
Blood Centre, Lund University Hospital, Lund, Sweden. josefina.dykes@transfumed.lu.se
Lindmark
A
A
Lenhoff
S
S
Winqvist
I
I
Johansson
B
B
Olofsson
T
T
Olsson
M L
ML
D002872:Chromosome Deletion; D002890:Chromosomes, Human, Pair 20; D015672:Erythroid Precursor Cells / Q000166:cytology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D017710:Lymphocyte Transfusion; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D012008:Recurrence; D012204:Rh-Hr Blood-Group System; D014184:Transplantation, Homologous
D012204:Rh-Hr Blood-Group System