“Donor cell-derived hematologic neoplasms are extremely rare complications that arise after hematopoietic stem cell transplantation.”
A young woman beat leukemia; however, nine years later, she faced a different blood cancer. This rare twist, reported recently in Oncotarget, reveals an unexpected risk of bone marrow transplants and opens new questions about long-term outcomes and donor screening.
Bone Marrow Transplant
Bone marrow transplants, also known as hematopoietic stem cell transplants, are often lifesaving for patients with blood cancers like leukemia. These transplants replace a patient’s damaged bone marrow with healthy cells from a donor, giving the body a fresh start. While this treatment can be remarkably effective, it comes with complex risks. Relapse of the original cancer is the most feared outcome. But in very rare cases, a different threat emerges; a cancer formed from the donor’s cells. This condition, called donor cell–derived hematologic neoplasm (DCHN), occurs in less than 1% of cases, and it can emerge years after a transplant.
The Case Report
Dr. Aleksandra Mroczkowska-Bękarciak and Dr. Tomasz Wróbel from Wroclaw Medical University in Poland recently published a new DCHN case report, titled “A case report of donor cell–derived hematologic neoplasms 9 years after allogeneic hematopoietic cell transplantation,” in Volume 16 of Oncotarget.
A female patient, diagnosed at age 12 with acute myeloid leukemia, received a bone marrow transplant from an unrelated donor. For nearly a decade, she lived cancer-free. But at age 23, an abnormal increase in platelet counts was noticed. Afterward, a series of extensive analyses, including advanced genetic sequencing, was performed to determine if the leukemia had returned. But it was not a cancer relapse. What was found was a new and distinct blood cancer: a triple-negative myeloproliferative neoplasm.
A New Cancer from Donor Cells
Genetic testing showed that the new cancer had developed from the donor’s cells, not from the patient’s own. These cells carried new mutations in three genes well-known in blood cancers: ASXL1, SETBP1, and EZH2. All three are associated with poor outcomes and aggressive disease progression.
Despite initial treatment, the patient’s condition deteriorated. Within two years, her illness had progressed to myelodysplastic syndrome and then to a new form of acute leukemia. Unfortunately, she died during therapy.
The Science Behind Donor Cell–Derived Hematologic Neoplasm
Researchers believe that a mix of factors can contribute to DCHN appearance: preexisting but undetected mutations in donor cells, damage to the patient’s bone marrow environment, stress on transplanted cells, and even the immunosuppressive therapies used to prevent transplant rejection.
What makes DCHN particularly difficult to detect is its delayed appearance. Years can pass before any symptoms appear.
The Importance of This Case
This case adds to a growing body of evidence that new cancers can originate from donor cells after a bone marrow transplant. It challenges the conventional understanding of relapse and highlights the need to reexamine how donor cells are screened and selected.
As stem cell transplants become more common, especially among younger patients, cases like this emphasize the need for better screening protocols and long-term monitoring. They also offer researchers valuable insights into how DCHN develops and how such complications might be prevented in the future, ultimately leading to more personalized and safer treatments.
Future Perspectives and Conclusion
This case illustrates that even the most advanced, life-saving treatments, like bone marrow transplants, can carry unexpected risks. It reinforces the need for continued vigilance, research, and innovation to make these therapies safer and more effective. Every patient’s story, especially the rare and complex cases like this one, adds to our understanding and brings us closer to more personalized, reliable treatments for all.
Click here to read the full case report in Oncotarget.
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Oncotarget is an open-access, peer-reviewed journal that has published primarily oncology-focused research papers since 2010. These papers are available to readers (at no cost and free of subscription barriers) in a continuous publishing format at Oncotarget.com.
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