Status:
Ready to upload
Record number:
2070
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Most recent risk assessment for leukemia, lymphoma and plasmacytoma (Council of Europe, 2022):
Leukaemia, lymphoma and plasmacytoma diagnosed during donor procurement: These cancers are classified as an unacceptable risk for organ donation. Leukaemia, lymphoma and plasmacytoma in the donor history: Active (acute or chronic) leukaemia, lymphoma and plasmacytoma are an unacceptable risk for organ donation. Treated acute leukaemia and lymphoma after a definite disease-free interval of 10 years may be considered for organ donation with an assumed high risk for transmission.
Time to detection:
7 years
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.
Imputability grade:
1 Possible
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Case report
Living donor
Cytogenetic analysis
DNA typing
Multiple myeloma
PTLD
Chemotherapy
Reference attachment:
Suggest references:
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.
Note:
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.