Autoimmunity Following Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

Autoimmune manifestations after allogeneic hematopoietic stem cell transplantation (AHSCT) are rare and poorly understood due to the complex interplay between the reconstituting immune system and transplant-associated factors. While autoimmune manifestations following AHSCT have been observed in children with graft-versus-host disease (GvHD), an alloimmune process, they are distinct from the latter in that they are generally restricted to the hematopoietic compartment, i.e., autoimmune hemolytic anemia, thrombocytopenia, and/or neutropenia. Autoimmune cytopenias in the setting of ASHCT represent a donor against donor immune reaction. Non-hematologic autoimmune conditions in the post-AHSCT setting have been described and do not currently fall under the GvHD diagnostic criteria, but could represent alloimmunity since they arise from the donor immune attack on the antigens that are shared by the donor and host in the thyroid, peripheral and central nervous systems, integument, liver, and kidney. As in the non-transplant setting, autoimmune conditions are primarily antibody mediated. In this article we review the incidence, risk factors, potential pathophysiology, treatment, and prognosis of hematologic and non-hematologic autoimmune manifestations in children after AHSCT.

Monogenic Immune Diseases Provide Insights Into the Mechanisms and Treatment of Chronic Graft-Versus-Host Disease

“…Autoantibody production may also occur due to disturbed T cell- B cell interaction and regulation ( 100 ). The highest rate of autoimmune cytopenias following HCT are reported in children undergoing HCT for non-malignant indications with anti-thymocyte globulin (ATG) or alemtuzumab-containing conditioning regimens ( 101 ).…”

Profile of Hepatobiliary Dysfunction in Hematopoietic Stem Cell Transplant Recipients: Autoimmune Diseases Also Contribute

“…In this regard, in my opinion, it would be relevant to recall that any possible autoimmune manifestation after transplantation has been reported. 2 In particular, the possibility of autoimmune hepatitis with development of typical and highly disease-specific autoantibodies (liver kidney type 1) has also been previously reported. 3,4 Therefore, I would consider appropriate that in the workup of patients developing hepatobiliary dysfunction after HSCT, the detection of autoantibodies of diagnostic significance for all autoimmune liver diseases, such as antinuclear, anti-smooth muscle, anti-liver-kidney, and antimitochondrial antibodies, may be helpful in a subset of pa-…”

Targeting plasma cells with daratumumab aids in the treatment of post‐transplant autoimmune‐like hepatitis

“…Among these, classic hepatic graft versus host disease (GVHD) mediated by an allogeneic T‐cell response has been well described 1 . However, other immune‐mediated complications, including antibody‐mediated autoimmune‐like hepatitis, are exceedingly rare 2 . Autoimmune‐like hepatitis is defined by portal eosinophilia and plasma cell infiltration 2–4 .…”

“…However, other immune‐mediated complications, including antibody‐mediated autoimmune‐like hepatitis, are exceedingly rare 2 . Autoimmune‐like hepatitis is defined by portal eosinophilia and plasma cell infiltration 2–4 . Patients reported with post‐HCT autoimmune‐like hepatitis have primarily been treated with systemic steroids, though given the rarity of this condition, there is no established standard treatment 5–7 …”