A 37 year old male was a donor for liver transplant two years back. During that period, his WBC count was found to be raised which has persisted till date. He was investigated one month ago and BCR-ABL mutation was positive. Should the recipient be investigated for Myeloproliferative disorder?

We do know that malignancies can be transplanted as passengers in organ allografts. Also passenger lymphocytes can be a major problem sometimes in transplants. CML developing post heart or liver transplant has been reported but it is always assumed that this is due to the profound immunosuppression associated with the allograft. Latency period for developing cml post transplant was usually less than a year.

There are no reports that I have discovered of transplanting cml. The late John Goldman and I investigated a situation where a cml patient of mine received an MUD graft from a donor across the Atlantic and then we thought relapsed 3 years later. About 5 years after that I discovered that the original donor had come down with CML. The question now of whether we had a relapse or a donor cml was raised, but the investigations that John and I did confirmed relapse not transfer.

I think that it would be fairly easy to to do a peripheral blood pcr for bcr-abl on this individual. It is very unlikely that cml was transplanted, but annual monitoring with a pcr, given how well cml can be treated, would not be a bad idea.

In the 1960ies pats with CML donated granulocyte transfusions to support pats in aplasia after chemotherapy. In some cases this resulted in a temporary engraftment of donor hematopoiesis and CML (See references below). As the liver also harbors CML cells - at least at the point of time CML is diagnosed - I would investigate the recipient of the transplant by checking his/her blood for BCR-Abl1 positivity.
Kind regards
Meinolf Suttorp

Vargas SO, Cannon ME, Benjamin RJ, Longtine JA.
Transfusion with blood from a donor with chronic myelogenous leukemia: persistence of the bcr/abl translocation in the recipient.
Transfusion. 1999 Apr;39(4):387-91.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
BACKGROUND: Transfusion of cells harvested from patients with chronic myelogenous leukemia (CML) as a therapeutic measure for patients with granulocytopenia was popular in the 1970s, when studies examining the persistence of transfused donor cells were limited by a lack of molecular techniques. Blood samples from a patient who recently received an inadvertent transfusion of CML cells were evaluated for the presence of the bcr/abl translocation characteristic of CML.
CASE REPORT: The patient, a 67-year-old man with a history of congestive heart failure, myocardial infarct, hypertension, diabetes mellitus, and chronic renal failure, was transfused for bleeding from colonic angiodysplasia. A volunteer blood donor reported that he had been diagnosed with CML 10 days after his donation. Three days after the donation, blood components from the donor with CML had been administered to the patient as nonirradiated red cells and platelets. Evaluation of donor blood by a reverse-transcriptase polymerase chain reaction showed the b3a2 transcript, indicating a bcr/abl translocation. Periodic testing of the patient's peripheral blood by the same technique demonstrated the presence of the b3a2 transcript on Days 74 and 75 after transfusion. The patient died of congestive heart failure 8 months after the transfusion.
CONCLUSION: In this rare case of accidental transfusion of neoplastic cells, the findings document the persistence of the donor's neoplastic clone in the recipient for 75 days.


Statement of the National CML Society (see webpage)
• Can leukemia be acquired through a blood transfusion?
Because there is no known cause of leukemia, the only way it could be acquired through a blood transfusion would be the direct introduction of leukemic cells in the recipient. However, because the cells of a random donor would be seen as foreign, they would be immediately destroyed by the recipient. There is no evidence that leukemia has ever been acquired from a blood transfusion.


Jiří Pavlů1, Richard M. Szydlo1, John M. Goldman1, and Jane F. Apperley1 Three decades of transplantation for chronic myeloid leukemia: what have we learned?
Blood 2011;117(3):755-763
………Interestingly, before patients with CML became recipients of hematopoietic stem cells, they functioned as donors. The high circulating leukocyte counts in newly diagnosed patients encouraged the use of these cells to replace granulocytes in patients with treatment-induced aplasia. Observers noted that the CML cells were able to engraft temporarily [10] and even change the blood group of the recipient, suggesting the presence of cells with engraftment potential in the peripheral blood.[11] In addition these infusions caused a graft-versus-host reaction [12] and it is now more than 40 years since Graw et al [13] described an allogeneic graft-versus-leukemia (GVL) effect with the disappearance of leukemia blasts after infusion of leukocytes from a CML donor into a patient with acute leukemia and intractable infection.[13] ……

10. Levin RH, Whang J, Tjio JH, Carbone PP, Frei E, Freireich EJ.
Persistent mitosis of transfused homologous leukocytes in children receiving antileukemic therapy.
Science 1963;142:1305-1311.
11. Bronson WR, McGinniss MH, Morse EE.
Hematopoietic graft detection by a change in ABO group.
Blood 1964;23(2):239-249.

12. Schwarzenberg L, Mathé G, Amiel JL, Cattan A,Schneider M, Schlumberger JR.
Study of factors determining the usefulness and complications of leukocyte transfusions.
Am J Med 1967;43(2):206-213.

13. Graw RG Jr., Buckner CD, Whang-Peng J, et al.
Complication of bone marrow transplantation. Graft-versus-host disease resulting from chronic-myelogenous-leukaemia leucocyte transfusions.
Lancet 1970;2(7668):338-341.