Changes in autoimmune thyroid disease following allogeneic bone marrow transplantation

Lee, W Y; Oh, Euichaul; Min, Chang‐Ki; Kim, D W; Lee, Jung Woo; Kang, Moo Il; Min, Woo-Sung; Y, B; Lee, K W; Son, Hyun-Shik; Kang, Suk‐Ku; Kim, C C

doi:10.1038/sj.bmt.1703102

Cited by 28 publications

(18 citation statements)

References 10 publications

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“…Post-HSCT AITD was first reported in 1987, 16 and a total 17 cases have since been reported (Table 3). [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] They included five cases of hypothyroidism and 12 cases of thyrotoxicosis. The male to female ratio in HSCT recipients was roughly equal (1.83:1), but similar to our experience, donors were markedly skewed to females (0.23:1).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune thyroid dysfunction after hematopoietic stem cell transplantation

Lie

Kung

et al. 2005

Bone Marrow Transplant

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Summary:Autoimmune thyroid disease (AITD) may occur in patients after hematopoietic stem cell transplantation (HSCT). In all, 10 cases of AITD (seven allogeneic and three autologous HSCT) were diagnosed among 721 HSCT recipients, including two patients with sequential hyper-and hypothyroidism. The 5-year actuarial rates for AITD after allogeneic and autologous HSCT were 2.9 and 4%, respectively. Significant risk factors included HSCT for chronic myeloid leukemia, the HLA B46 and DR9 loci and the A2B46DR9 haplotype, while female donors showed trend to significance. On multivariate analysis, only female donors and HLA DR9 remained significant. For autologous HSCT, the associations with HLA B46 and DR9 were also significant. Only three donors had a family history of AITD. A review of other reported cases confirmed the predominance of female donors, although the other associations including graftversus-host disease, familial AITD and other autoimmune phenomena might be related to reporting bias. Since the actuarial incidence of AITD from female donors with predisposing HLA alleles may be over 30%, susceptible recipients should be carefully monitored. Owing to the small number of reported cases and different HLA associations with AITD in different populations, our observations await confirmatory data from other registries.

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Section: Discussionmentioning

confidence: 99%

Autoimmune thyroid dysfunction after hematopoietic stem cell transplantation

Lie

Kung

et al. 2005

Bone Marrow Transplant

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22] The AID preceded the onset of aplastic anemia by 0.2-25 (median 3) years. Prior treatment for AID included gold salts, antirheumatic or thyroistatic drugs in at least 10 patients.…”

Section: Allogeneic Sctx For Aplastic Anemia and A Concomitant Autoimmentioning

confidence: 99%

“…18,19 Four other patients received additional antithymocyte globulin alone (ATG) 15 or anti-lymphocyte globulin (ALG) together with procarbazine. 22 Standard graft-versushost prophylaxis was given to all patients post transplant and consisted of methotrexate and cyclosporine, alone, or in combination.…”

Section: Allogeneic Sctx For Aplastic Anemia and A Concomitant Autoimmentioning

confidence: 99%

Clinically demonstrable anti-autoimmunity mediated by allogeneic immune cells favorably affects outcome after stem cell transplantation in human autoimmune diseases

Hinterberger

Hinterberger-Fischer

Marmont

2002

Bone Marrow Transplant

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Summary:To determine the role of allogeneic, autologous and syngeneic hemopoietic stem cell transplantation (SCTx) as a treatment for severe autoimmune disease (AID) we performed a literature search employing Medline, Cancer Lit and abstract books for reports on transplants for blood disorders and a concomitant AID. All reviews, case reports and abstracts available between June 1977 and September 2001 were used and attempts made to update them by e-mail by the corresponding authors. Disease-free survival (DFS) after allogeneic SCTx for 23 patients with severe aplastic anemia was 78% at 16 years and survival in unmaintained remission of concomitant AID was 64% at 13 years. DFS after allogeneic SCTx for 24 patients with hematologic malignancies was 87% at 15 years and survival in unmaintained remission for concomitant AID was 70% at 11 years. DFS after autologous SCTx for 24 patients with hematologic malignancies was 48% at 6 years and survival in unmaintained remission for concomitant AID was 29% at 3 years. Among 30 patients given allogeneic SCTx 19 developed graft-versus-host disease (GVHD) and 11 did not. Upon clinically justified discontinuation of all immunosuppressive therapy, 3/11 patients without GVHD relapsed with their concomitant AID (freedom of AID-relapse 69% at 9 years), whereas none of 19 patients with GVHD did so (log rank: P ‫؍‬ 0.0135). Freedom of AID-relapse was superior after allo SCTx compared to autologous SCTx (89% at 18 years vs 38% at 5 years; log rank: P ‫؍‬ 0.0002). Our data suggest that a graft-versus-autoimmunity effect after allogeneic hemopoietic SCTx mediates elimination of autoimmunity.

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“…Donor antibody transfers, immune-mediated injury, conditioning treatment effects, post-transplant medications and patient susceptibility may play a role in post-hematopoietic stem cell transplantation hypothyroidism. Case studies have shown that a donor with autoimmune thyroid disorder may transfer cell capable of injuring the recipient's thyroid gland after hematopoietic stem cell transplantation (Lee et al 2001;Marazuela, and Steegman 2000). Immune-mediated thyroid injury arising in the host has been suggested in other studies and may be a form of graftversus-host-disease (Kami et al 2001;Katsanis et al 1990;Somali et al 2005).…”

Section: Allogeneic Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%