Would like to think that the Eligix system could prevent this from happening in transplants...
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T-Cell Lymphoma Transmitted by Allogeneic Bone Marrow Transplantation
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WESTPORT, CT (Reuters Health) Nov 16 - A T-cell lymphoma was transmitted by donor bone marrow from one sister to another who was being treated with allogeneic bone marrow transplantation for anaplastic large-cell lymphoma of T-cell lineage. The case is described in the November 15th issue of the New England Journal of Medicine.
Though most post-transplantation cancers originate from exposure to genotoxic agents or to Epstein-Barr virus, according to the authors, rare tumors can stem from neoplastic cells that accompany transplanted tissue.
Dr. James R. Eshleman, from Johns Hopkins School of Medicine in Baltimore, Maryland, and colleagues report on two sisters who both developed subcutaneous panniculitic T-cell lymphoma years after the bone marrow transplant. Findings from polymerase chain reaction analysis were suggestive of the presence of identical T-cell clones in the two tumors, the authors report. The patterns in both tumors matched the donor's germ-line pattern.
"Tumor-specific polymerase chain reaction analysis of peripheral-blood cells obtained from the donor before transplantation revealed a T-cell receptor-gamma clone identical in size to that in her tumor," the researchers say, "demonstrating that her blood contained clonal T cells when her marrow cells were harvested."
The donor's neoplastic T-cell clone persisted in her sister for at least 5 years before clinical evidence of the lymphoma emerged, according to the authors.
"This case is a fortunately a rare occurrence," Dr. Eshleman said in e-mail comments to Reuters Health. "Since the tumor had its own unique tumor-specific genetic fingerprint (the rearranged T-cell receptor), we believe that this is one of the best-documented cases of tumor transmission during transplantation."
"Since more sensitive assays need to be developed, we do not recommend any specific changes [in donor assessment] at this time," Dr. Eshleman said.
He did propose "four major approaches to preventing such cases in the future: (1) greater purification of stem cells (to eliminate contaminating tumor cells), (2) aggressive screening of donors (though this donor was asymptomatic at the time of donation), (3) if donors develop tumors, design sensitive tumor-specific assays to screen transplant recipients, and (4) develop better assays to test for such clones."
N Engl J Med 2001;345:1458-1463. |
