Murata Makoto, Ishikawa Yuichi, Ohashi Haruhiko, Terakura Seitaro, Ozeki Kazutaka, Kiyoi Hitoshi, Naoe Tomoki
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, Aichi, 466-8550, Japan.
Department of Infectious Diseases, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Int J Hematol. 2008 Jul;88(1):111-115. doi: 10.1007/s12185-008-0094-3. Epub 2008 May 10.
A 49-year-old male developed recurrent acute myeloid leukemia 27 months after allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-identical brother. The immunophenotype of the blastic cell population was incompatible with that of the pre-transplant blast cells; a mutation in C/EBPA gene was found in the pre-transplant blast cells that was not present in the post-transplant blast cells, and short tandem repeat analysis of marrow cells, which included 71% blasts, showed complete donor chimera. Thus, this recipient developed donor cell leukemia (DCL). The donor was healthy when DCL developed in the recipient as well as before donation of the peripheral blood stem cells. Only five cases of DCL after PBSCT have been reported in the literature. As a mechanism for the development of DCL, a vigorous proliferative demand on the donor cells, which often correlates with a higher likelihood of replication error or mutation, has been proposed. Peripheral blood stem cells might have an advantage in that they are associated with a low incidence of DCL development because PBSCT recipients receive a higher total cell dose than recipients of bone marrow or cord blood cells.
一名49岁男性在接受来自 HLA 配型相同的兄弟的异基因外周血干细胞移植（PBSCT）27个月后发生复发性急性髓系白血病。原始细胞群体的免疫表型与移植前原始细胞的免疫表型不相符；在移植前原始细胞中发现了 C/EBPA 基因突变，而移植后原始细胞中不存在该突变，对包含71%原始细胞的骨髓细胞进行短串联重复分析显示为完全供体嵌合体。因此，该受者发生了供体细胞白血病（DCL）。当受者发生DCL时以及在捐献外周血干细胞之前，供者均健康。文献中仅报道了5例PBSCT后发生DCL的病例。作为DCL发生的一种机制，有人提出对供体细胞有旺盛的增殖需求，这通常与复制错误或突变的可能性较高相关。外周血干细胞可能具有优势，因为与骨髓或脐血细胞的受者相比，PBSCT受者接受的总细胞剂量更高，DCL发生的发生率较低。
