Secondary autoimmune diseases occurring after HSCT for an autoimmune disease: a retrospective study of the EBMT Autoimmune Disease Working Party

Abstract

To specify the incidence and risk factors for secondary autoimmune diseases (ADs) after HSCT for a primary AD, we retrospectively analyzed AD patients treated by HSCT reported to EBMT from 1995 to 2009 with at least 1 secondary AD (cases) and those without (controls). After autologous HSCT, 29 of 347 patients developed at least 1 secondary AD within 21.9 (0.6-49) months and after allogeneic HSCT, 3 of 16 patients. The observed secondary ADs included: autoimmune hemolytic anemia (n ‫؍‬ 3), acquired hemophilia (n ‫؍‬ 3), autoimmune thrombocytopenia (n ‫؍‬ 3), antiphospholipid syndrome (n ‫؍‬ 2), thyroiditis (n ‫؍‬ 12), blocking thyroid-stimulating hormone receptor antibody (n ‫؍‬ 1), Graves disease (n ‫؍‬ 2), myasthenia gravis (n ‫؍‬ 1), rheumatoid arthritis (n ‫؍‬ 2), sarcoidosis (n ‫؍‬ 2), vasculitis (n ‫؍‬ 1), psoriasis (n ‫؍‬ 1), and psoriatic arthritis (n ‫؍‬ 1). After autologous HSCT for primary AD, the cumulative incidence of secondary AD was 9.8% ؎ 2% at 5 years. Lupus erythematosus as primary AD, and antithymocyte globulin use plus CD34 ؉ graft selection were important risk factors for secondary AD by multivariate analysis. With a median follow-up of 6.2 (0.54-11) years after autologous HSCT, 26 of 29 patients with secondary AD were alive, 2 died during their secondary AD (antiphospholipid syndrome, hemophilia), and 1 death was HSCT-related. This European multicenter study underlines the need for careful management and follow-up for secondary AD after HSCT. (Blood. 2011;118(6):1693-1698)

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

“…Although the primary autoimmune disease may be suppressed after HSCT, nearly 10 % of patients undergoing HSCT for an autoimmune disease have been reported to develop a second autoimmune illness unrelated to their indication for autologous HSCT within the first 2 years after HSCT [62]. Autoimmune thyroid disease occurred in half of these cases.…”

“…A retrospective registry review reports a 9 % incidence of secondary autoimmunity among patients who received ATG during HSCT conditioning, but secondary autoimmune disease occurred in only 4 % of patients who did not receive a lymphocyte-depleting agent [62]. Alemtuzumab may be more potent at inducing secondary autoimmune phenomenon, as the incidence of secondary autoimmunity was noted to be 16 % when alemtuzumab was included in the conditioning regimen, but only 2 % with ATG in a large single-center experience [63].…”

Complications of autologous hematopoietic stem cell transplantation for patients with autoimmune diseases

“…We thus recently analyzed the incidence and risk factors for the development of a secondary AD after HSCT in 363 patients reported to Promise (38). Among 363 primary AD patients included from 28 centers in 12 European countries, 32 developed at least one secondary AD after HSCT.…”

Sjögren’s syndrome associated chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) treated with autologous and subsequently allogeneic haematopoietic SCT (HSCT)

“…Secondary ADs have been reported following both auto-and allo-HSCT for primary ADs. 11 The sequence of three ADs in this patient strongly suggests a genetic background, and the switch from one AD to the other is reminiscent of Shoenfeld's kaleidoscope of the autoimmune mosaic. 12 …”