J Hematol

Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc

Journal website https://jh.elmerpub.com

Case Report

Volume 000, Number 000, February 2025, pages 000-000

Donor Cell-Derived Chronic Lymphocytic Leukemia Presenting After Allogenic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia

Figure 1. Case 2 - flow cytometry analysis of the donor (a-e) and the recipient (f-j). CD19 cells were gated on the SSC/CD19 dot plot (a, f). In blood of the donor, cells show weaker expression of CD20 (b; y-axis), but stronger expression of CD23 (b; x-axis), compared to the recipient cells (g). (c) and (h) display expression of CD43 (x-axis) versus CD20 (y-axis). CD43 expression is slightly weaker in the donor than in the recipient. (d) and (i) show a significant difference in expression of FMC-7, which is stronger in the donor (d) in comparison with the recipient (i). The expression of CD5 is present in the donor (e), contrary to the lack of CD5 expression in the recipient’s blood (j).

**Table 1.** Review of the Literature (Reported Cases of Donor-Derived CLL)
Case number	Reference	Primary diagnosis	Patient’s age at DCL diagnosis	Donor	Source of stem cells	Donor origin confirmation	Age of donor at the moment of donation	Time from allo-HSCT to diagnosis of DCL	GVHD	Malignant clone in donor	Disease in donor	Time from donation to donor malignancy
^aDetection of clonal B-cell population with CLL phenotype, no proof of CLL criteria met at that time. ALL: acute lymphocytic leukemia; AML: acute myeloblastic leukemia; BM: bone marrow; CLL: chronic lymphocytic leukemia; CML: chronic myelocytic leukemia; DCL: donor cell leukemia; FISH: fluorescence in situ hybridization; GVHD: graft-vs-host disease; HSCT: hematopoietic stem cell transplantation; HLA: human leukocyte antigen; HSC: hematopoietic stem cells; IgH: immunoglobulin heavy chain; IgK: immunoglobulin kappa light chain; MDS: myelodysplastic syndrome; ND: no data; NHL: non-Hodgkin lymphoma; PB: peripheral blood; PCR: polymerase chain reaction; Sib: sibling donor; STR: short tandem repeats; VNTR: variable number of tandem repeats.
1	[5]	MDS	62	Sib	PB	VNTR	70	28 days	Yes	Yes	No	-
2	[5]	CML	16	Unrelated	BM	IgH VDJ rearrangement detection by PCR	45	12 years/10 years to clone	Yes	Yes	Yes	2 years
3	[5]	NHL	52	Unrelated	PB	VNTR	51	28 days	Yes	ND	ND	ND
4	[6]	CLL	51	Sib (twin)	BM	IgH analysis	45	6 years	No	Yes	Yes	ND
5	[7]	AML	65^a	Sib	ND	FISH	62	3 months^a	No	Yes	Yes	26 months
6	[8]	CML	64	Sib	PB	STR, IgH analysis	67	8 years	Yes	Yes	No	-
7	[9]	CLL	54^a	Sib	PB	FISH	58	5.58 years^a	Yes	Yes	Yes	5 years
8	[10]	ALL	12^a; 15	Unrelated	ND	IgH and IgK analysis, FISH	44	4 years^a; 7.5 years	Yes	Yes	Yes	1 year
9	[1]	ALL	36	Unrelated	BM	VNTR or STR	ND	9.98 years	No	ND	ND	ND
10	[1]	AML	59	Sib	PB	VNTR or STR/FISH	ND	10.02 years	No	Yes	Yes	9.07 years
11	[1]	CLL	50	Sib	PB	HLA typing	ND	0.28 years	No	Yes	Yes	1.42 years
12	Current case 1	AML	65	Sib	PB	STR	64	9.16 years	Yes	Yes	Yes	9.51 years
13	Current case 2	AML	62	Sib	PB	STR	50	3.17years	Yes	Yes	Yes	3.33 years

Table 1. Review of the Literature (Reported Cases of Donor-Derived CLL)

Case number

Reference

Primary diagnosis

Patient’s age at DCL diagnosis

Donor

Source of stem cells

Donor origin confirmation

Age of donor at the moment of donation

Time from allo-HSCT to diagnosis of DCL

GVHD

Malignant clone in donor

Disease in donor

Time from donation to donor malignancy

^aDetection of clonal B-cell population with CLL phenotype, no proof of CLL criteria met at that time. ALL: acute lymphocytic leukemia; AML: acute myeloblastic leukemia; BM: bone marrow; CLL: chronic lymphocytic leukemia; CML: chronic myelocytic leukemia; DCL: donor cell leukemia; FISH: fluorescence in situ hybridization; GVHD: graft-vs-host disease; HSCT: hematopoietic stem cell transplantation; HLA: human leukocyte antigen; HSC: hematopoietic stem cells; IgH: immunoglobulin heavy chain; IgK: immunoglobulin kappa light chain; MDS: myelodysplastic syndrome; ND: no data; NHL: non-Hodgkin lymphoma; PB: peripheral blood; PCR: polymerase chain reaction; Sib: sibling donor; STR: short tandem repeats; VNTR: variable number of tandem repeats.

[5]

MDS

Sib

VNTR

28 days

Yes

[5]

CML

Unrelated

IgH VDJ rearrangement detection by PCR

12 years/10 years to clone

Yes

2 years

[5]

NHL

Unrelated

VNTR

28 days

Yes

[6]

CLL

Sib (twin)

IgH analysis

6 years

Yes

[7]

AML

65^a

Sib

FISH

3 months^a

Yes

26 months

[8]

CML

Sib

STR, IgH analysis

8 years

Yes

[9]

CLL

54^a

Sib

FISH

5.58 years^a

Yes

5 years

[10]

ALL

12^a; 15

Unrelated

IgH and IgK analysis, FISH

4 years^a; 7.5 years

Yes

1 year

[1]

ALL

Unrelated

VNTR or STR

9.98 years

[1]

AML

Sib

VNTR or STR/FISH

10.02 years

Yes

9.07 years

[1]

CLL

Sib

HLA typing

0.28 years

Yes

1.42 years

Current case 1

AML

Sib

STR

9.16 years

Yes

9.51 years

Current case 2

AML

Sib

STR

3.17years

Yes

3.33 years