Donor Cell Leukemia: A Review Daniel H. Wiseman  Biology of Blood and Marrow Transplantation  Volume 17, Issue 6, Pages 771-789 (June 2011) DOI: 10.1016/j.bbmt.2010.10.010 Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Number of reported cases of donor cell leukemia (DCL) by year of publication (1971-2010). Biology of Blood and Marrow Transplantation 2011 17, 771-789DOI: (10.1016/j.bbmt.2010.10.010) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 Proposed mechanisms and other etiologic factors influencing development of donor cell leukemia (DCL). Several putative mechanisms have been proposed to contribute critical “hits” toward leukemogenesis in cells of donor origin following transplantation into a new host. Genetic factors might prime stem cells with a preleukemic phenotype within the donor, with a range of recipient- and therapy-specific factors probably interacting to contribute toward realization of malignant potential following engraftment into the more conducive bone marrow environment of the recipient. A “multiple hit” hypothesis has been proposed, with DCL probably the convergent endpoint of numerous distinct pathways (which may vary between individual cases). Biology of Blood and Marrow Transplantation 2011 17, 771-789DOI: (10.1016/j.bbmt.2010.10.010) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 Kaplan-Meier curve depicting overall survival (OS) in all reported cases of donor cell leukemia (DCL). Overall, at least 34 patients had died before publication, at a median of 5.5 months after DCL diagnosis. At least 24 patients remained alive at publication, at a median of 14 months follow-up. Reinduction chemotherapy with apparently curative intent had been attempted in at least 47 cases. Detailed outcome data were available for 41 patients. Median OS for treated patients was estimated at 32.8 months (95% confidence interval: 22.5-43.1 months). For the Kaplan-Meier estimate, surviving patients were censored at last reported follow-up. Insufficient data were provided for analysis of event-free survival (EFS) or other detailed outcome parameters. Biology of Blood and Marrow Transplantation 2011 17, 771-789DOI: (10.1016/j.bbmt.2010.10.010) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions