Management of autoimmune diseases after haematopoietic stem cell transplantation

Abstract

Summary Autologous and allogeneic haematopoietic stem cell transplantation (HSCT) is an option for the treatment of malignant and non‐malignant diseases, including the severe autoimmune diseases. Intriguingly, the ‘new’ autoimmunity developing after transplantation is a constantly recognized phenomenon, which has to be differentiated from original disease relapse, toxicity, infection and graft‐versus‐host disease. The reported autoimmune diseases occurring in this setting are mainly antibody‐associated and organ‐specific, with scarce evidence in support for specific treatment options. This review focuses on current concepts on the pathogenesis, the available data on incidence, risk factors, manifestations and treatment of post‐HSCT autoimmune diseases.

New autoimmune diseases after cord blood transplantation: a retrospective study of EUROCORD and the Autoimmune Disease Working Party of the European Group for Blood and Marrow Transplantation

“…[1][2] Mostly, these "new" ADs are autoantibody-mediated and organ specific (eg, autoimmune thyroiditis, autoimmune hemolytic anemia [AIHA], or immune thrombocytopenia [ITP]); more rarely, they are multisystemic (eg, systemic lupus erythematosus [SLE] or rheumatoid arthritis [RA]). Data on incidence and risk factors are only emerging, and this has been first investigated in a larger cohort for ADs occurring after HSCT used as treatment option for primary AD.…”

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

“…These autoimmune disorders have been previously related to the use of unrelated donors and development of GVHD, probably reflecting a dysregulation of the immune system in these settings. 1,2 These autoimmune cytopenias (ACs) have been recently described among patients undergoing umbilical cord blood transplantation (UCBT), in case reports and in a registry-based study that analyzed autoimmune disorders in a cohort of patients with malignant and non-malignant diseases in both children and adults. 3 The aim of the present study was to analyze the incidence of AC, as well as to describe the presenting clinical features, specific serological data, response to therapy and outcome in a large series of adult patients that received single-unit UCBT at a single institution.…”

Graft versus self (GvS) against T-cell autoantigens is a mechanism of graft–host interaction

“…The activation or induction of such allogeneic, autoreactive T cells could be based on several mechanisms including decreased thymic selection as shown in murine models (27,35) or an impaired thymic function during allogeneic HCT and GVHD, leading to impaired immunological reconstitution (36,37). Also, impaired function of regulatory T cells (e.g., through conditioning regimens or immunosuppression) could play a role (34).…”

“…Notably, the term new autoimmunity is commonly referred to diseases that share laboratory findings and clinical presentation with normal autoimmune diseases including detection of disease specific antibodies (37). In contrast, alloreactivity denotes recognition of antigens, based on structural differences between donor and recipient.…”