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Blood, 15 March 2007, Vol. 109, No. 6, pp. 2643-2548.
Prepublished online as a Blood First Edition Paper on November 21, 2006; DOI 10.1182/blood-2006-07-035766.
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TRANSPLANTATION
Development of a secondary autoimmune disorder after hematopoietic stem cell transplantation for autoimmune diseases: role of conditioning regimen used
Yvonne Loh1,
Yu Oyama1,
Laisvyde Statkute1,
Kathleen Quigley1,
Kimberly Yaung1,
Elizabeth Gonda1,
Walter Barr2,
Borko Jovanovic3,
Robert Craig1,4,
Dusan Stefoski5,
Bruce Cohen6, and
Richard K. Burt1
1 Division of Immunotherapy,
2 Division of Rheumatology,
3 Department of Preventive Medicine,
4 Division of Gastroenterology, and
6 Department of Neurology, Northwestern University Feinberg Medical Center, Chicago, IL;
5 Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
Patients undergoing autologous hematopoietic stem cell transplantation (auto-HSCT) for autoimmune disease may have an added propensity to develop a second autoimmune disorder, given the genetic predisposition to autoimmunity. Therefore, we undertook a retrospective analysis of all patients who have undergone auto-HSCT for an autoimmune disease in our institution to determine the occurrence of a second autoimmune disorder and possible risk factors. In all, 155 patients underwent auto-HSCT for various autoimmune diseases; of those patients, 6 manifested a distinct secondary autoimmune disease at a median of 8.5 months (range, 2-30 months) after auto-HSCT. There were 2 patients with systemic lupus erythematosus, conditioned with a regimen containing antithymocyte globulin (ATG), who developed factor VIII inhibitors with severe bleeding. There were 4 patients (2 with multiple sclerosis, one each with lupus and systemic sclerosis) who received an alemtuzumab-containing conditioning regimen who developed autoimmune cytopenias. Among the 155 patients, the frequency of secondary autoimmune complications was 16.0% with alemtuzumab (4/25), 1.9% for ATG (2/102), and 0% for conditioning regimens without lympho-depleting antibodies (0/28)—a difference that was found to be significantly higher with alemtuzumab exposure (P = .011). In contrast, sex, type of ATG used, and CD34-selection of peripheral blood stem cells were not found to be significantly associated with development of a secondary autoimmune disorder.
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