Post-transplant acute myeloid leukemia (PT-AML)

Acute myeloid leukemia following organ transplantation (PT-AML) is a rare e vent with only a few published cases in the literature. We present three pa tients who developed AML (FAB M1, M5, M4) after renal, double lung or liver transplantation. Molecular analysis detected a t(9;11) in one patient and documented the recipient origin of AML in a second patient. All patients we re treated with chemotherapy. Immunosuppression was reduced to cyclosporin A (CsA) and prednisone in two patients and to prednisone alone in one patie nt. Two patients achieved a complete remission (CR), with a remission durat ion of 4.6 months in one patient, the other patient died from septicemia af ter 15.2 months in CR. One patient was refractory to chemotherapy and died from septicemia. This report together with the documented cases in the lite rature suggests that PT-AML (1) develops after a median interval of 5 years after transplantation with variable latency (range, <1-17 years); (2) is h eterogeneous with respect to FAB classification; (3) shows chromosomal and molecular changes typical of therapy-related AML (t-AML: -7, +8, 11q23, inv 16, t(15;17)); (4) standard chemotherapy is feasible after reduction of imm unosuppression and produces a CR rate of 56% with a median remission durati on of 4.6 months and an overall survival of 2.6 months; (5) the major compl ications are early death (25%), Gram-negative septicemia, progressive disea se or relapse. This review provides diagnostic and therapeutic experiences and guidelines for the management of this increasing group of post-transpla nt patients.