Donor-cell leukemia after bone marrow transplantation for severe aplastic anemia

Article Abstract:

Acute leukemia following bone marrow transplantation to treat severe aplastic anemia is unusual, but has been documented. This is the first report of donor-cell leukemia after bone marrow transplantation for aplastic anemia. The case of a 19-year-old man with severe aplastic anemia is discussed. He was given a bone marrow transplant from an allogenic (unrelated) donor; no evidence of subsequent graft-versus-host disease was observed. Nine months later he was diagnosed with acute leukemia. Using new techniques and the application of polymerase chain reaction (PCR) analysis, it was determined that the disease originated in the donor cells. The donor's blood test results have remained normal after a year and a half. Previously, leukemia after transplantation was found to originate in host cells, and was thought to result from a pre-existing disorder. Transmission of myeloid leukemia from an affected donor to the recipient has occurred, but the disease was detectable in the donor marrow at the time of transplantation. In this case, the donor remained well, and the abnormality was not discernable at the time of transplantation. The cause of this case of leukemia is unknown. Leukemia induced by chemotherapy takes much longer to develop, and the authors know of no case of leukemia caused by cyclophosphamide, which is used to suppress the immune system in patients undergoing transplantation. New techniques in cytogenetics (genetic study of cells) and molecular biology will contribute greatly to finding the answers to this and similar questions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Polymerase chain reaction, Aplastic anemia, Acute leukemia

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Inadvertent transmission of a donor's acute myeloid leukemia in bone marrow transplantation for chronic myelocytic leukemia

Article Abstract:

A 29-year-old woman developed chronic myelocytic leukemia in 1981, and was treated with hydroxyurea until 1987. In that year she received a bone marrow transplant; the donor was her brother, who was histocompatibly identical. Although a blood test had revealed no abnormalities in the donor, a routine smear of the bone marrow observed after the operation revealed the presence of pathological cells indicating acute myeloid leukemia. One month after the operation, the donor developed leukemia. The donor received a bone marrow transplantation, but subsequently relapsed and died after refusing another transplantation. The initial recipient developed acute myeloid leukemia five months after receiving the diseased bone marrow from her brother. Examination of the cells conclusively confirmed that the leukemia cells were male, and must have come from the transplanted marrow. The woman was treated with another transplant, this time from a different sibling, but died about 11 months after the original bone marrow transplantation. The authors point out that a similar unfortunate event has not occurred in over 4,000 bone marrow transplantations. Nevertheless, a routine diagnostic bone marrow examination prior to the transplantation would have prevented the inadvertent transplantation of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Disease transmission, Leukemia

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Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission

Article Abstract:

High-dose chemotherapy appears to be as effective as a bone marrow transplant in patients with acute myeloid leukemia. Researchers treated 740 patients with acute myeloid leukemia with standard chemotherapy until they went into remission. Then they were randomly assigned to receive a bone marrow transplant or high-dose chemotherapy. Some received their own bone marrow donated while they were in remission and some from another donor. There were no differences in survival between those who received high-dose chemotherapy and those who received a bone marrow transplant.

Dosage and administration, Chemotherapy, Acute leukemia, Promyelocytic, Acute myelocytic leukemia

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