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Donor cell-derived myelodysplastic syndrome after cord blood transplantation

Bone Marrow Transplantation volume 43, pages 429–431 (2009)Cite this article

Donor cell-derived hematological malignancy is a rare complication after allogeneic SCT. Earlier studies reported that 0.12–5% of patients developed donor cell leukemia (DCL) after allogeneic SCT.1, 2 Recently, several reports have shown that donor cell-derived hematological malignancy occurred in patients after cord blood transplantation (CBT).3, 4, 5, 6, 7, 8, 9 Here, we report an adult case with ALL that subsequently developed donor cell-derived myelodysplastic syndrome (MDS) after CBT.

We presented here a patient who developed donor cell-derived MDS after CBT. Late-onset progressive pancytopenia after allogeneic SCT is usually due to late graft failure. However, in our case, the repeated evidence of complete donor chimerism and clonal chromosomal abnormalities confirmed the diagnosis of donor cell-derived MDS after CBT. The published cases of donor cell-derived hematological malignancies after CBT are presented in Table 1. Literature review including our case reveals eight cases of donor cell-derived hematological malignancies after CBT, excluding post transplant lymphoproliferative disease.3, 4, 5, 6, 7, 8, 9 Of the eight cases reported, four were male and four female. The median age of the patients was 32 years (range, 1–57 years). The conditioning regimen was based on the conventional myeloablative regimen in six patients and the reduced-intensity regimen in two patients. The median time between CBT and diagnosis of donor cell-derived hematological malignancies was 10.5 months (range, 80 days to 40 months). Three of the patients were transplanted for the diagnosis of ALL, two for AML, one for adult T-cell leukemia/lymphoma, one for Langerhan's cell histiocytosis and one for Hodgkin's lymphoma. Donor cell-derived hematological malignancies after CBT included AML in five cases, MDS in two cases and chronic myeloproliferative disease in one case. Chromosomal abnormalities involving seven were detected in five of eight cases. The methods used to diagnose donor origin were short tandem repeats or variable number of tandem repeats analysis in four cases, FISH analysis in three cases and G-banding analysis in one case. Three patients died of donor cell-derived hematological malignancies. Second SCT was performed in three patients. Among these three patients, only one is alive in remission and the remaining two experienced transplant-related death. Although the cord blood donor in our case is well and healthy over a period of at least 6 months after birth, further information of donor's health conditions is unavailable. The mechanism for causing DCL after allogeneic SCT is not well understood. Various factors might contribute to the development of DCL after allogeneic SCT. These included impaired tumor surveillance, chronic antigenic stimulation by differences between donor and recipient cells, perturbations within the host bone marrow microenvironment, premature aging of the donor cells, and associated chromosomal instability.1 In addition, the presence of preleukemic clones found only rarely in cord blood samples might contribute to the development of DCL after CBT.10 However, there are no common mechanisms of DCL. Interestingly, chromosomal abnormalities with monosomy 7 or deletion 7q were detected in four of eight cases of donor cell-derived hematological malignancies after CBT. The involvement of chromosome 7 abnormalities might be associated with donor cell-derived hematological malignancies after CBT in some cases as well as SCT using BM cells.11 Further research and the increasing number of reports will improve the understanding of the clinical implications of the donor cell-derived hematological malignancies after CBT.

Table 1 Summary of published cases of donor cell-derived hematological malignancies after CBT
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Acknowledgements

We are indebted to the medical and nursing staff who cared for patients in this study and thank Maki Monna-Oiwa for her secretarial assistance.

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  1. Department of Hematology and Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    T Konuma, J Ooi, S Takahashi, A Tomonari, N Tsukada, S Kato, A Sato, F Monma, E Hongo, K Uchimaru, A Tojo & S Asano

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  1. T Konuma
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Correspondence to J Ooi.

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Konuma, T., Ooi, J., Takahashi, S. et al. Donor cell-derived myelodysplastic syndrome after cord blood transplantation. Bone Marrow Transplant 43, 429–431 (2009). https://doi.org/10.1038/bmt.2008.344

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