Myeloid Neoplasms Following Solid Organ Transplantation: Clinicopathologic Studies of 11 Cases
Steven T Kramer, Deepti M Reddi, Chuanyi M Lu, Jerold Gong, Catherine Rehder, Endi Wang. Duke University Medical Center, Durham, NC; UCSF, San Francisco, CA; Thomas Jefferson University, Philadelphia, PA
Background: The risk for neoplasms secondary to organ transplantation is significantly increased and most are lymphoproliferative disorders (LPD). In contrast, myeloid neoplasms are rare after organ transplantation and their clinicopathologic features have not yet been characterized.
Design: We identified 11 cases of myeloid neoplasms in patients with solid organ transplantation by searching in our pathology database. The clinicalpathologic features and follow-up information have been retrospectively reviewed and analyzed.
Results: Of 11 cases, 6 are male and 5 are female. Age ranges: 1-67 years (median 44) at organ transplantation; 2-75 years (median 48) at myeloid neoplasm diagnosis. The median interval between transplantation to the myeloid neoplasm diagnosis was 70 months (range: 12-312). The transplanted organs include liver (5), lung (2), kidney (2) and heart (2), with all donors unrelated to the recipients. Types of myeloid neoplasms acquired: acute myeloid leukemia (AML) in 7, chronic myelogenous leukemia (CML) in 2 and myelodysplastic neoplasm (MDN) in 2 cases. Of the 7 cases with AML, 2 had significant circulating blasts while the other 5 showed absent-rare circulating blasts. Characteristic bone marrow morphology was present in both cases. All 11 cases exhibited clonal cytogenetic abnormalities: isolated Philadelphia chromosome (2), 11q23 abnormalities (3), -7q (2), inversion 16 (1), -5q (1) and hyperdiploidy (2). Follow-up information was available in 9 cases, while the other 2 cases were too recently diagnosed for sufficient follow-up. Four patients died within 2 months of treatment, 1 relapsed at 36 months after treatment, and 4 were alive (both CML cases) with median follow up of 6 months (range 6-28).
Conclusions: Myeloid neoplasms that occur after organ transplantation have a longer latency similar to those observed in neoplasms related to alkylator/radiotherapy or EBV-negative post-transplant LPDs. The rate and pattern of cytogenetic abnormalities also appears similar to those found in cases related to alkylator/radiotherapy. The clinical outcome seems to be unfavorable. Whether the occurrence of myeloid neoplasms in this setting attributes to decreased immune surveillance or mutagenic effect of transplant medications remains to be studied.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 222, Wednesday Morning