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‘Two Sister Study’ Shows How Lymphoma Develops

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A new case study looking at the evolution of follicular lymphoma shows for the first time how the blood cancer develops inside the human body. This insight is giving scientists a first look at how a common malignant ancestor can be passed from donor to recipient.

The phenomenon of a donor passing a malignancy to a recipient is well-documented, but considered a minimal risk to those in the transplant community says David Weinstock, M.D., an assistant professor of medicine at Dana-Farber Cancer Institute.

He says what is unique about this case, dubbed "The Study of Two Sisters", is it’s giving scientists an rare opportunity to better understand the genetic abnormalities that led to grade 2/3A follicular lymphoma developing in biological sisters after one donated bone marrow to the other. This insight may translate into earlier treatment for future lymphomas.

The study involves a 41-year-old woman diagnosed with chronic-phase chronic myeloid leukemia, who received a bone marrow transplant and subsequent leukocyte infusion from her sister. These treatments controlled her leukemia, but seven years later, each sister developed follicular lymphoma, a common type of non-Hodgkin Lymphoma (NHL) that begins in certain white blood cells (lymphocytes) and adversely affects the person’s immune system.

“We were able to combine clinical activity with laboratory expertise to gain a real insight into the biology involved,” says Dr. Weinstock, lead author of the case study, published first online in the December 2011 issue of Cancer Discovery, a professional journal of the American Association for Cancer Research. The findings were presented on Dec. 12, at the 2011 American Society of Hematology Annual Meeting and Exposition in San Diego, Calif.

Weinstock and his colleagues sequenced the DNA of samples derived from each of the sisters as well as a frozen sample of the white blood cell (leukocyte) infusion to determine the genetic lesions that led to the lymphoma.

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