ACUTE-LEUKEMIA FOLLOWING RENAL-TRANSPLANTATION

Four renal transplant patients on immunosuppressive therapy who presen ted with acute myeloid leukaemia are described. In two cases, azathiop rine may have played an important role as a cofactor in leukaemogenesi s. In a third case, the alkylating agent cyclophosphamide may have con tributed. All patients were treated for leukaemia with full doses of c ytotoxic chemotherapy and, in each case, a functioning renal allograft was preserved throughout the treatment despite attenuation of immunos uppressive therapy. Three patients achieved complete remission. Of the three, one is surviving at 2 years and two expired during the pancyto penic phase of their treatment with no active leukaemia present, and w ith intact renal function. As increasing expertise in the held of orga n transplantation allows patients to survive longer, such patients' ex posure to immunosuppressive and potentially leukaemogenic drugs is pro longed. The risk of secondary neoplasia has been previously documented in this population. Two of the four cases reported here suffered from polycystic kidney disease as their underlying condition. While this r eport suggests that the leukaemias are related to renal transplantatio n, we cannot rule out an association with the underlying disease which led to the transplant. This report further suggests that the leukaemi a that develops in such patients may respond to standard therapy, and that such treatment does not compromise the transplanted kidney.