A 53-year-old male developed acute erythroleukemia three years after renal transplantation. He had received three years of immunosuppressive therapy with azathioprine. A preleukemic phase associated with chromosome abnormalities was recognized. Azathioprine has been associated with chromosome abnormalities. The chronic stimulation of an abnormal erythroid clone by transplantation may have hastened the development of erythroleukemia.
Cancer 43:1924-1926, 1979.
H E INCREASED INCIDENCE of malignancy
T in immunosuppressed organ transplant recipients is now well documented.'*'0*" Although lymphoreticular tumors are commonly reported, acute leukemia is a rare occurrence.' In this paper, we report a case of erythroleukemia in a renal transplant recipient receiving longterm azathioprine therapy.
CASE REPORT
The patient was a 53-year-old male, who presented in April 1970 with hypertension and chronic renal failure. A renal biopsy demonstrated chronic glomerulonephritis; and the patient received azathioprine, 100 mg per day, for six months. He began hemodialysis in March 197 1, and in August 1973, he received a kidney from a cadaver donor.
A single, acute rejection episode was treated with local radiotherapy, cyclophosphaniide and prednisone. Maintenance therapy with azathioprine and prednisone, at a dose of 3 mg/kg and 0.1 mg/kg, respectively, was continued uneventfully for three years.
In May 1976, after three years of continuous immunosuppressive therapy, he presented with pancytopenia which persisted after azathioprine was stopped. The hemoglobin was 6.4 g/dl. the