{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:05:39Z","timestamp":1779771939570,"version":"3.53.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Donor cell-derived leukemia (DCL) is a rare complication of allogeneic hematopoietic cell transplantation (allo-HCT), previously described in patients receiving allo-HCT for hematologic malignancies. Allo-HCT has also been investigated as an immunotherapy platform for solid tumors including clear cell renal cell carcinoma (RCC). Herein, we describe a unique patient case treated by allo-HCT for RCC who subsequently developed DCL. A 40-year-old man was diagnosed with metastatic clear cell RCC treated surgically by left nephrectomy plus metastasectomy of a rib lesion. He was referred to the Fred Hutchinson Cancer Center and treated by allo-HCT as part of a clinical trial (NCT00005851). His initial allograft following fludarabine\/2 Gy total body irradiation (TBI) conditioning was complicated by graft failure. After collecting a G-CSF-mobilized autologous hematopoietic stem cell product as a failsafe for repeated graft failure, he was re-transplanted from the same donor following cyclophosphamide\/antithymocyte globulin (ATG) conditioning, resulting in successful engraftment. Fourteen months later, he developed donor origin acute myelomonocytic leukemia with central nervous system (CNS) involvement. He was treated by 7\u00a0+\u00a03 induction with intrathecal methotrexate and was able to achieve complete remission. He subsequently underwent autologous hematopoietic cell transplantation (auto-HCT) without further leukemia relapse. Unfortunately, 4 years after his auto-HCT, he developed recurrent RCC, initially managed by surgical resections. Upon further progression, he was then treated with sequential lines of systemic therapy that included pazopanib, nivolumab, cabozantinib, and lenvatinib\/everolimus. He died from complications of his RCC 17 years after his second successful allograft. The absence of pre-transplant systemic therapies for the patient\u2019s metastatic RCC and ongoing good health of the donor implicates a leukemogenic potential of his transplant-associated therapies including TBI, cyclophosphamide, and ATG. His uncommonly long survival from metastatic RCC suggests clinical benefit was derived from the 14-month duration of allo-HCT associated with T-cell allo-immunity previously shown capable of targeting RCC-associated minor histocompatibility antigens.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1830323","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:42:36Z","timestamp":1779770556000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: donor cell-derived leukemia after allogeneic stem cell transplantation for metastatic renal cell carcinoma"],"prefix":"10.3389","volume":"17","author":[{"given":"Federico","family":"Monaco","sequence":"first","affiliation":[{"name":"Azienda Ospedaliero-Universitaria SS Antonio e Biagio e Cesare Arrigo, S.C.D.U. Ematologia","place":["Alessandria, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danh T.","family":"Tran","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center, Clinical Research Division","place":["Seattle, WA, United States"]},{"name":"Division of Hematology and Oncology, University of Washington","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda M.","family":"Sandmaier","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, University of Washington","place":["Seattle, WA, United States"]},{"name":"Fred Hutchinson Cancer Center, Translational Science and Therapeutics Division","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott S.","family":"Tykodi","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Center, Clinical Research Division","place":["Seattle, WA, United 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