New autoimmune diseases after autologous hematopoietic stem cell transplantation for multiple sclerosis

Richard K. Burt, Paolo A. Muraro, Dominique Farge, Maria Carolina Oliveira, John A. Snowden, Riccardo Saccardi, Xiaoqiang Han, Kathleen Quigley, Valquiria Bueno, Daniela Frasca, Denis Fedorenko, Joachim Burman

Research output: Contribution to journalReview articlepeer-review

Abstract

Secondary autoimmune diseases (2ndADs), most frequently autoimmune cytopenias (AICs), were first described after allogeneic hematopoietic stem cell transplantation (HSCT) undertaken for malignant and hematological indications, occurred at a prevalence of ~5–6.5%, and were attributed to allogeneic immune imbalances in the context of graft versus host disease, viral infections, and chronic immunosuppression. Subsequently, 2ndADs were reported to complicate roughly 2–14% of autologous HSCTs performed for an autoimmune disease. Alemtuzumab in the conditioning regimen has been identified as a risk for development of 2ndADs after either allogeneic or autologous HSCT and is consistent with the high rates of 2ndADs when using alemtuzumab as monotherapy. Due to the significant consequences but variable incidence, depending on conditioning regimen, of 2ndADs and similarity in known immune reconstitution kinetics after autologous HSCT for autoimmune diseases and after alemtuzumab monotherapy, we propose that an imbalance between B and T lineage regeneration early after HSCT may underlie the pathogenesis of 2ndADs.

Original languageEnglish (US)
Pages (from-to)1509-1517
Number of pages9
JournalBone Marrow Transplantation
Volume56
Issue number7
DOIs
StatePublished - Jul 2021

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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