Acute T Cell Lymphoblastic Leukemia in the Recipient of a Renal Transplant from a Donor with Malignant Lymphoma

and renal function remained good. Ultrasound scans of the graft were normal. In December 2005, 6 month after transplantation, she developed general malaise. A mild leukopenia and thrombocytopenia was noted. Bone marrow biopsy revealed massive infiltration of blasts. The morphologic features of cells were similar to lymphoblastic lymphoma, expressing cyCD3+, TdT+, CD1a+ and CD8+ ( fig. 1 ). These findings were consistent with ALL L2, cortical type, based on the French-American-British and immunological classification, respectively. The immunophenotyping analysis showed the same antigenic profile of the abnormal T cells both in the thymus of the donor and the bone marrow of the recipient. Because this adult female received an allograft from a male donor, fluorescence in situ hybridization (FISH) studies for sex chromosomes were performed to evaluate the origin of the blastic cells. The FISH procedure was performed according to the manufacturer’s instructions (VYSIS, Downers Grove, Ill., USA), with slight modifications. The slides and directly labeled chromosome Y DNA probes were denaturated in the 73 8 1 ° C denaturant bath (70% formamide/2 ! SSC) for 5 min, dehydrated for 1 min in 70% EtOH, 1 min in 85% EtOH, and 1 min in 100% EtOH. Hybridization was performed at 37 ° C for 16 h. The posthybridization washes were done by immersing slides Organ transplant recipients are at risk of donor-related malignancies [1] . It is estimated that malignancy is transmitted in one in every 3,500 allografts, the most common being melanoma [1, 2] . The cases of posttransplantation lymphoma arising in allografted tissues have also been reported [3] . To the best of our knowledge, no example exists of an acute lymphoblastic leukemia (ALL), T-cell type, accidentally transplanted to a renal recipient from a donor with the malignant lymphoma, lymphoblastic T cell. The blood donor, a 19-year-old male patient who died of deep cerebral anoxia after choking on a tablet, had no family history of malignancy. His family consented to multiorgan transplantation. In June 2005, at the time of organ retrieval no abnormalities were detected. After transplantation, autopsy was performed and it demonstrated a limited infiltration of a mediastinal tumor arising in thymus. A diagnosis of T cell lymphoblastic lymphoma was made. The recipient of the first kidney, a 59year-old woman with a history of end-stage renal disease secondary to glomerulonephritis, having been informed of the donor autopsy findings, decided to retain her allograft. Immunosuppression consisted of tacrolimus, mycophenolate mofetil and prednisolone. At the first, third and 5-month assessments she was asymptomatic Received: January 24, 2008 Accepted after revision: March 21, 2008 Published online: June 9, 2008