Development of leukemia in donor cells after allogeneic stem cell transplantation--a survey of the European Group for Blood and Marrow Transplantation (EBMT).
Leukemia in donor cells (donor cell leukemia; DCL) has been reported as a rare but severe complication of allogeneic stem cell transplantation (SCT). However, the incidence, potential pathogenetic factors, therapeutic options and outcome of patients suffering from DCL and the leukemia risk of their donors are not well defined. A questionnaire survey was carried out within European Blood and Marrow Transplantation Group (EBMT) centers. Ninety-one EBMT centers participated in this survey, covering 10489 allogeneic SCT between 12/1982 and 09/2003. Fourteen cases of DCL, most with a myeloid phenotype (7 cases of acute myeloid leukemia, 3 each of acute lymphocytic leukemia and 1 case of chronic myeloid leukemia) were identified. Demonstration of donor cell origin included molecular analysis of chimerism in most cases. DCL type and cytogenetic alterations were independent from the original disease. The median time between transplantation and diagnosis of DCL was 17 months (4-164). No type of conditioning, donor, graft manipulation, graft-versus-host disease prophylaxis or subsequent complications were identified as risk factors for DCL. Chemotherapy induced remissions in DCL and 2 of 5 patients remain alive in remission after a second transplant. None of the stem cell donors developed hematologic malignancies (median follow-up period of 9 years; range 6-30 years). DCL is an extremely rare complication of allogeneic SCT in which treatment attempts with chemotherapy and a second SCT are justified. Donors are not at an increased risk of developing hematologic malignancies.
Hertenstein
Bernd
B
Hannover Medical School, Department of Hematology and Oncology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Hertenstein.Bernd@mh-hannover.de
Hambach
Lothar
L
Bacigalupo
Andrea
A
Schmitz
Norbert
N
McCann
Shaun
S
Slavin
Shimon
S
Gratwohl
Alois
A
Ferrant
Augustin
A
Elmaagacli
Ahmet
A
Schwertfeger
Rainer
R
Locasciulli
Anna
A
Zander
Axel
A
Bornhäuser
Martin
M
Niederwieser
Dietger
D
Ruutu
Tapani
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005060:Europe; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007938:Leukemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome