Multiple unrelated clonal abnormalities in host bone marrow cells after allogeneic stem cell transplantation.
A 22-year-old man with chronic myeloid leukemia (CML) received fractionated total body irradiation (TBI) (1440cGy) and etoposide (60 mg/kg) followed by infusion of 10 x 10(6) /kg CD34+ selected stem cells from his mother. Donor and recipient were 50% matched at the HLA-A and -B loci and 100% at HLA-DR. Mixed lymphocyte culture reaction was negative. Post-stem cell transplant (SCT) immunosuppression consisted of antithymocyte globulin, cyclosporine, and prednisone, and was discontinued after 7 months. The donor graft was rejected 2 years post-SCT. At 7 years post-SCT, he is clinically well with normal blood counts and no evidence of CML or myelodysplasia despite the presence over 6 years of multiple clones with balanced translocations and deletions in host bone marrow cells. The emergence of clonal hematopoiesis may provide insights into therapy-related leukemogenesis.
Kebriaei
Partow
P
Department of Medicine and Cancer Research Center, University of Chicago, 5841 S. Maryland Avenue, MC 2115, Chicago, IL 60637, USA.
Winter
Jane N
JN
Laport
Ginna G
GG
Le Beau
Michelle M
MM
Dewald
Gordon
G
Larson
Richard A
RA
D000328:Adult; D001854:Bone Marrow Cells / Q000473:pathology* / Q000648:ultrastructure; D002869:Chromosome Aberrations; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D008297:Male; D014184:Transplantation, Homologous