Case report: Acute Myeloid Leukemia (AML) (2002)

- Most recent risk assessment for myeloproliferative disorders (includes chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, primary myelofibrosis) (Council of Europe, 2025): Myeloproliferative neoplasms (MPNs) diagnosed during donor procurement: Organs from patients with MPNs should only be accepted with the highest caution and only after consultation with an experienced haemato-oncologist Results of the bone marrow biopsy should be carefully evaluated. A patient admitted with unspecific but suspect symptoms like extensive thrombo-/erythro-/leukocytosis should be tested for specific oncogenes in blood and bone marrow (CD34+ cells, BCR-ABL, JAK-2, V617F-mutation, MPL-mutation, Calretikulin- mutation) to distinguish an MPN from a simply reactive situation. Since this will take 2-3 working days, it might not be suitable in the context of organ donation. Myeloproliferative neoplasms in the donor history: Due to the systemic and chronic character of these diseases and the lack of evidence on their behaviour in the setting of organ transplantation (and in the immunosuppressed recipient), their transmission risk cannot currently be fully assessed. Organs from these patients should only be accepted with the highest caution. The following laboratory tests might be obtained to assess the actual situation of the pre-diagnosed MPN: complete and differential blood count, liver enzymes including LDH. Bone marrow biopsy can help to rule out blasts at the time of donation. Patients with spleno-/hepatomegaly need particular attention. An experienced haematologist should always be asked for an assessment. It might be reasonable to accept an organ donor with a pre-diagnosed MPN for selected recipients, especially in cases of confirmed MPN without need for treatment or in cases where the diagnosis has been confirmed years ago and good therapy results were obtained. Primary myelofibrosis (PMF) seems to be more risky due to a higher proportion of circulating blasts and might bear an even higher risk for transmission.