title: Donor cell leukemia with bone marrow necrosis.
abstract: A 60-year-old man with myelodysplastic syndrome underwent allogeneic transplantation of female umbilical cord blood in 2010 and sustained a complete remission. He experienced severe pain in his left hip joint and was admitted to the orthopedic surgery division of our institution in February 2015. After admission, he was suspected to have hemophagocytic syndrome (HPS) and was thus transferred to the hematology division. Bone marrow aspiration revealed hyper-cellular marrow filled with abnormal collapsed cells, consistent with bone marrow necrosis (BMN). As there was no evidence of infection, collagen disease, or occult cancer, he was diagnosed with HPS of unknown origin and treated with dexamethasone, cyclosporine A, and etoposide according to the HLH-2004 protocol. Although his general condition and laboratory findings showed amelioration, morphologically abnormal cells appeared in peripheral blood two weeks after treatment. Bone marrow aspiration showed BMN with increased abnormal cells, positive for CD117 and MPO. Sex chromosome FISH analysis revealed donor chimerism and cytogenetic analysis showed 46XX, +1, der (1;7) (q10;q10). He was diagnosed with donor cell leukemia (DCL) and received salvage chemotherapy. However, he died because of severe pneumonia and sepsis without neutrophil recovery at day 68. We herein report this rare case of DCL with BMN.
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ikegawa
authors.forename: Yuho
authors.initials: Y
authors.lastname: Najima
authors.forename: Naoki
authors.initials: N
authors.lastname: Sano
authors.forename: Shin-Ichiro
authors.initials: SI
authors.lastname: Horiguchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaito
authors.forename: Shuhei
authors.initials: S
authors.lastname: Kurosawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sakaguchi
authors.forename: Kaito
authors.initials: K
authors.lastname: Harada
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hino
authors.forename: Keita
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Senoo
authors.forename: Daisuke
authors.initials: D
authors.lastname: Watanabe
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Kyoko
authors.initials: K
authors.lastname: Watakabe
authors.forename: Aiko
authors.initials: A
authors.lastname: Igarashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Doki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kakihana
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Hishima
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Ohashi
mesh_terms: D001855:Bone Marrow Diseases / Q000150:complications* / Q000473:pathology*; D017809:Fatal Outcome; D050723:Fractures, Bone / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D051359:Lymphohistiocytosis, Hemophagocytic; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000150:complications; D014019:Tissue Donors