Chronic granulocytic leukemia and carcinoma of the cervix in situ following renal transplantation.

A 26-year-old white female presented with Philadelphia chromosome positive chronic granulocytic leukemia five years after successful renal transplantation and prolonged therapy with azathioprine and prednisone. This patient represents the seventh case of the chronic granulocytic leukemia reported within the population of immunosuppressed renal transplant recipients. Of further interest in our case is the development of carcinoma in situ of the cervix two years following the transplant. Although multiple malignancies have been recognized in renal homografts, the occurrence of chronic granulocytic leukemia and carcinoma in situ in the same patient has not been previously described. A possible mechanism for the development of chronic granulocytic leukemia is the association of chromosome damage by azathioprine and immunoparalysis of the host, thus setting the stage for the emergency of a malignant clone. The importance of close follow-up of patients on prolonged immunosuppressive therapy is emphasized.