Bioethical considerations of monoclonal B-cell lymphocytosis: donor transfer after haematopoietic stem cell transplantation.
Monoclonal B-cell lymphocytosis (MBL) is a recently described laboratory finding in otherwise healthy individuals. In MBL, a light chain-restricted, clonal B-cell population, often with a chronic lymphocytic leukaemia (CLL) phenotype, is identified by flow cytometry. Although the prognostic significance remains unclear, there is an increased incidence in ageing populations and those with a family history of CLL. During the past decade of MBL study, three families have come to our attention in which prospective sibling haematopoietic stem cell donors were found to have an MBL. These families raise complex bioethical issues with regard to disclosure of research data, eligibility for clinical trials and potential donor transfer of MBL. These issues are explored in this report. Identification of MBL among prospective sibling transplant donors will become a common occurrence in transplant practice as transplantation is increasingly offered to older individuals and those with CLL.
Hardy
Nancy M
NM
Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Grady
Christine
C
Pentz
Rebecca
R
Stetler-Stevenson
Maryalice
M
Raffeld
Mark
M
Fontaine
Laura S
LS
Babb
Rebecca
R
Bishop
Michael R
MR
Caporaso
Neil
N
Marti
Gerald E
GE
D001402:B-Lymphocytes; D026688:Bioethical Issues; D001853:Bone Marrow / Q000473:pathology; D000075202:Contraindications; D018380:Hematopoietic Stem Cell Transplantation / Q000941:ethics*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics / Q000628:therapy*; D019520:Living Donors / Q000941:ethics; D008218:Lymphocytosis / Q000235:genetics* / Q000473:pathology; D014342:Truth Disclosure / Q000941:ethics