title: Systematic donor blood qualification by flow cytometry would have been able to avoid CLL-type MBL transmission after unrelated hematopoietic stem cell transplantation.
abstract: The current screening for eligibility of unrelated volunteer marrow donors comprises a complete clinical check-up, a blood CBC and serum protein immunoelectrophoresis. This allows to eliminate acute leukemias, myeloproliferative and myelodysplastic disorders, myelomas and MGUS. To date, the risk of transmission of chronic lymphocytic leukemia (CLL) disease is only evaluated by the clinical evaluation and CBC. We report here the case of a CLL-type MBL disease occurring in a 12-year-old boy after unrelated BMT. Deep biological investigations, as Immunophenotyping, cytogenetic and molecular biology allow us to determine the donor origin of the CLL clone. In 2010, 14.2% donor (105/737) for unrelated hematopoietic stem cell transplantation were over 45y. It is currently estimated (USA) that 1 in 210 men and women will be diagnosed with CLL during their lifetime. Given the long asymptomatic phase of CLL, this raises the case for a detection strategy analog to that used for MGUS and myeloma through serum protein electrophoresis. This case-report, to our knowledge, of a CLL-type MBL unrelated donor-to-recipient transmission through BMT raises ethical and practical questions, such as the proper information about disease transmission risk. The cost-effectiveness of a systematic peripheral blood Immunophenotyping in donors elder than 40y at time of stem cell donation should be evaluated.
authors.affiliation: INSERM UMR645, IFR133, Etablissement Français du sang Bourgogne Franche-Comté, Besançon, France. christophe.ferrand@efs.sante.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Ferrand
authors.forename: Francine
authors.initials: F
authors.lastname: Garnache-Ottou
authors.forename: Marie Agnès
authors.initials: MA
authors.lastname: Collonge-Rame
authors.forename: Fabrice
authors.initials: F
authors.lastname: Larosa
authors.forename: Michel
authors.initials: M
authors.lastname: Blanc
authors.forename: Catherine
authors.initials: C
authors.lastname: Behar
authors.forename: Catherine
authors.initials: C
authors.lastname: Giannoli
authors.forename: Frédérico
authors.initials: F
authors.lastname: Garnier
authors.forename: Pierre
authors.initials: P
authors.lastname: Tiberghien
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Pierre Simon
authors.initials: PS
authors.lastname: Rohrlich
mesh_terms: D000328:Adult; D001483:Base Sequence; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000592:standards*; D002648:Child; D005260:Female; D005434:Flow Cytometry; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D015322:Gene Rearrangement, B-Lymphocyte; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D016130:Immunophenotyping; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000209:etiology* / Q000517:prevention & control*; D008218:Lymphocytosis / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D011786:Quality Control; D061349:Unrelated Donors
chemical_list: D016044:Fusion Proteins, bcr-abl