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Adverse Occurrence type:
Most recent risk assessment for leukemia (Council of Europe, 2018): donors with active leukemia are considered to represent an unacceptable risk for tumor transmission. Data at this time do not allow for discrimination of individual types of leukemias. Donors with treated leukemia after a disease-free interval of 5 to 10 years are assumed to represent a high risk for tumor transmission.
Time to detection:
Alerting signals, symptoms, evidence of occurrence:
Mother to daughter living donor kidney transplant. The donor (mother) developed multiple myeloma 1 year after donation and died the following year. Increased serum protein in the recipient (daughter) 7 years postransplant prompted studies showing a monoclonal component. Bone marrow biopsy showed mixed chimerism by short tandem report analysis. Insufficient tissue to evaluate Ig gene rearrangement but both tumors were IgG lambda. Chromosomal abnormalities in the two tumors were different. No EBV was present. The transplant kidney was not involved.
Demonstration of imputability or root cause:
Absence of IgG gene rearrangement studies and difference in cytogenetic analysis suggest the possibility of two separate clones in the two tumors. It is not known if the donor had myeloma at the time of transplant, though this can be likely given that symptomatic disease arose one year later. The findings support the authors' conclusion that donor cells with a propensity to neoplastic transformation were probably transmitted at transplant, rather than a fully developed neoplasm (tumor arose 7 years posttransplant). In essence, the tumor arose from donor cells but a frank malignancy was not transmitted at time of transplant, i.e. a "donor-derived" tumor.
Suggest new keywords:
Fujiwara SI, Ikeda T, Morita K, Shinzato T, Ishikawa N, Nakamura N, et al. Multiple myeloma derived from a kidney transplant donor who also developed myeloma after kidney donation. Am J Transplant. 2019.
agree to MIchael, Carl-ludwig
Expert comments for publication:
The authors note that this would be considered a PTLD according to WHO classification. A counterargument can be made that tumors proven or strongly suspected to arise by other mechanisms such as proven or strongly suspected donor transmission of neoplastic or preneoplastic cells should not be classified under the umbrella term of PTLD despite histologic overlap with the accepted commonly occurring subtypes. In this case it was possible to preserve the allograft by antineoplastic chemotherapy and autologous stem cell transplantation.