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However, it has significant risks including relapsed malignancy, infection, and graft versus host disease. Rarely, de novo malignancy can arise from donor cells. Chimerism analysis is used to monitor engraftment and predict rejection or disease relapse. Our patient underwent an allogeneic transplant for myelodysplastic syndrome but had persistent pancytopenia despite donor lymphocyte infusion. This was due to donor\u2010derived malignancy, which was predicted by loss of a satellite marker on chimerism analysis 6\u2009months prior. This could have allowed earlier intervention and underscores the importance of detailed chimerism monitoring.<\/jats:p>","DOI":"10.1155\/crh\/8230549","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T11:01:38Z","timestamp":1762858898000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Early Is Too Early? 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