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

Abstract

Key Points• Autoimmune diseases do occur after CBT in approximately 5% of patients.• Of these, AIHA or ITP were observed the most often and were treated with prednisone, CSA, and RTX.To describe the incidence, risk factors, and treatment of autoimmune diseases (ADs) occurring after cord blood transplantation (CBT), we analyzed both CBT recipients reported to EUROCORD who had developed at least 1 new AD and those who had not. Fifty-two of 726 reported patients developed at least 1 AD within 212 days (range, 27-4267) after CBT. Cumulative incidence of ADs after CBT was 5.0% ؎ 1% at 1 year and 6.6% ؎ 1% at 5 years. Patients developing ADs were younger and had more nonmalignant diseases (P < .001). ADs target hematopoietic (autoimmune hemolytic anemia, n ‫؍‬ 20; Evans syndrome, n ‫؍‬ 9; autoimmune thrombocytopenia, n ‫؍‬ 11; and immune neutropenia, n ‫؍‬ 1) and other tissues (thyroiditis, n ‫؍‬ 3; psoriasis, n ‫؍‬ 2; Graves disease, n ‫؍‬ 1; membranous glomerulonephritis, n ‫؍‬ 2; rheumatoid arthritis, n ‫؍‬ 1; ulcerative colitis, n ‫؍‬ 1; and systemic lupus erythematosus, n ‫؍‬ 1). Four patients developed 2 ADs (3 cases of immune thrombocytopenia followed by autoimmune hemolytic anemia and 1 Evans syndrome with rheumatoid arthritis). By multivariate analysis, the main risk factor for developing an AD was nonmalignant disease as an indication for CBT (P ‫؍‬ .0001). Hematologic ADs were most often treated with steroids, rituximab, and cyclosporine. With a median follow-up of 26 months (range, 2-91), 6 of 52 patients died as a consequence of ADs. We conclude that CBT may be followed by potentially life-threatening, mainly hematologic ADs. (Blood. 2013;121(6):1059-1064)

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

“…However, this recent registry-based study described an apparently lower incidence of AC among the subgroup of adults with hematological malignancies. 3 In this regard, a single-center study using strict and careful case definitions may more reliably reflect the true incidence of this complication in a real-world scenario. Four patients developed AIT, although the incidence of this complication could have been underestimated owing to the fact that prolonged thrombocytopenia with poor graft function is frequent after UCBT and that AIT is mostly a diagnosis of exclusion.…”

“…This association has already been reported. 2,3 It is known that chronic GVHD is associated with an abnormal immune function and predisposes to autoimmune disorders. 25 This finding supports the inclusion of AC as manifestations of chronic GVHD, as has been proposed by the National Institutes of Health consensus criteria.…”

“…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.…”

Autoimmune Demyelinating Polyneuropathy as a Manifestation of Chronic Graft-versus-Host Disease after Adult Cord Blood Transplantation in a Patient with Chronic Lymphocytic Leukemia

“…The extent of autoimmune diseases after cord blood transplantation was recently reported through a retrospective analysis from the Eurocord registry [6]. In this Eurocord analysis, fifty-two out of 726 cord blood recipients developed at least 1 autoimmune disease with a cumulative incidence of 5% at one year after transplantation.…”

“…Six of the 52 patients who developed autoimmune complications ended up dying as a result of these complications. Of note, there were no autoimmune neurologic manifestations in this large retrospective series [6]. …”