Late onset post-transplantation lymphoproliferative disease of recipient origin following cytogenetic relapse and occult autologous haematopoietic regeneration after allogeneic bone marrow transplantation for acute myeloid leukaemia

A post-transplantation lymphoproliferative disease (PTLD) of recipient orig in was identified in one of 376 consecutive cases of allogeneic bone marrow transplantation (EMT). This occurred in a 36-year-old woman who received a n allogeneic BMT for acute myeloid leukaemia in relapse. At 15 months after BMT, recipient haematopietic and leukaemic cells were found in the bone ma rrow, which disappeared on withdrawal of immunosuppression. However, severe graft-versus-host disease (GVHD) necessitated the continuation of immunosu ppression, leading to the occurrence of PTLD in the liver and lung 12 month s afterwards. Fluorescence in situ hybridisation showed that the neoplastic cells were of recipient origin. Although the PTLD also responded completel y to withdrawal of immunosuppression, the patient finally died from the com plications of GVHD. This case of late onset PTLD post-BMT showed features s imilar to those in solid organ transplantation, in that the tumour was of r ecipient origin and responded well to the withdrawal of immunosuppression. Of further interest is that recipient lymphoid regeneration had accompanied autologous haematopoietic regeneration and become a target for subsequent neoplastic transformation.