Vitiligo after Hematopoietic Cell Transplantation: Six Cases and Review of the Literature

Abstract

Aim: To investigate the prevalence and clinical characteristics of vitiligo after allogeneic hematopoietic cell transplantation (AHCT). Methods: The development of vitiligo was analyzed among 421 patients who underwent AHCT in Ibni Sina Hospital (University of Ankara) between 1988 and 2004. Results: Among 421 patients, we describe 6 with generalized vitiligo occurring after AHCT for chronic myelogenous leukemia. Five of them had severe chronic graft-versus-host disease (GVHD). Vitiligo was accompanied by alopecia areata and acquired ichthyosis in 2 patients with GVHD. Conclusion: Melanocyte destruction caused by the autoimmune reactions triggered by chronic GVHD as well as a genetic predisposition might have played a role in the development of vitiligo in our patients. These data support the hypothesis that vitiligo is an autoimmune entity.

Enfermedad injerto contra huésped cutánea crónica tipo vitiligo. Caso clínico

“…The main hypothesis regarding its etiology considers it as an autoimmune disease due to the destruction of melanocytes as a dependent response of cytotoxic T-lymphocytes 6 . Chronic cutaneous GVHD implies the appearance of antibodies that could act as a triggering factor to develop autoimmune diseases, and in this case, to start an autoimmune response focused on the destruction of melanocytes, which is manifested as vitiligo 6 . The association of GVHD with multiple autoinmune diseases, such as Sjögren syndrome, systemic scleroderma, Hashimoto's thyroiditis and Grave's disease support this theory 7 .…”

Autoimmune Complications after Hematopoietic Stem Cell Transplantation in Children with Nonmalignant Disorders

“…We found no difference between conditioning with or without antithymocyte globulin. The pretransplant serologic status of cytomegalovirus (CMV) in the recipient is associated with an increased probability of chronic GVHD [32] and could potentially increase the development of AICs. In our study, most patients (5/7) developed autoimmune cutaneous manifestations associated with CMV reactivation, whereas this association could not be confirmed in other AICs.…”

Mucous Membrane Pemphigoid with Antibodies to the β3Subunit of Laminin 332 in a Patient with Acute Myeloblastic Leukemia and Graft-versus-Host Disease

“…However, it might be possible that undiscovered slight attacks of GVHD triggered these cases of MMP, since more than 10 cases of autoimmune blistering diseases, mostly BP, after allogeneic BMT have been reported to date [18,19] . Indeed, various autoimmune diseases, including vitiligo, have been shown to develop in patients with GVHD [20,21] , although the mechanism is unknown. It is possible that some cases may stem from donor-related transfer of pathogenic lymphocytes (autoreactive B cells against laminin 332 in our case) or their progenitors, while most of the cases can be attributed to the immunological imbalances after BMT [20] .…”