Clinical Report: Early T-cell Precursor Acute Lymphoblastic Leukemia Arising from Donor Cells

Overview

This case study presents a pediatric patient who developed early T-cell precursor acute lymphoblastic leukemia (ETP-ALL) from umbilical cord blood donor cells following allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia. The patient underwent multiple chemotherapy regimens but did not achieve remission.

Background

Donor cell leukemia (DCL) is a rare complication following allo-HSCT, particularly when the donor cells are derived from umbilical cord blood. The incidence of DCL varies widely, and understanding the mechanisms behind DCL is crucial for improving prevention and therapeutic strategies.

Data Highlights

Key Findings

• The patient developed ETP-ALL 2 years and 5 months post-allo-HSCT.
• Umbilical cord blood cells may have inherent tumor precursor characteristics.
• Multiple chemotherapy regimens were administered, but the patient did not achieve remission.
• The case highlights the refractory nature of donor cell leukemia.

Clinical Implications

This case underscores the importance of monitoring for donor cell leukemia in patients undergoing allo-HSCT, particularly those receiving umbilical cord blood. Clinicians should be aware of the potential for aggressive disease and the challenges in achieving remission.

Conclusion

The occurrence of ETP-ALL from donor cells post-transplantation illustrates the risks associated with using umbilical cord blood in hematopoietic stem cell transplantation.

Related Resources & Content

1. Frontiers in Immunology, Case Report: Safety and efficacy of blinatumomab in combination with donor lymphocyte infusion for the prophylaxis of relapse following allogeneic hematopoietic stem cell transplantation in a pediatric patient with acute lymphoblastic leukemia, 2026
2. Blood Cancer Journal, Nonengraftment donor lymphocyte infusions for refractory acute myeloid leukemia, 2015
3. the asco post, Pinpointing Contributing Factors in Response to Posttransplant Donor Lymphocyte Infusion in Patients With AML, 2025
4. Frontiers in Immunology, Case Report: Donor Cell-Derived Leukemia after Allogeneic Stem Cell Transplantation for Metastatic Renal Cell Carcinoma, 2026
5. Donor cell-derived haematological neoplasms after allogeneic haematopoietic cell transplantation: recommendations from the EBMT Practice Harmonisation and Guidelines Committee, 2026
6. Donor cell-derived haematological neoplasms after allogeneic haematopoietic cell transplantation: recommendations from the EBMT Practice Harmonisation and Guidelines Committee - PubMed
7. https://medfind.link/wp-content/uploads/2025/04/PediatricAcuteLymphoblasticLeukemia_2025.V3_EN.pdf