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Post-Transplant Events

Autoimmune thyroid dysfunction after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 35, pages 383–388 (2005)Cite this article

Summary:

Autoimmune thyroid disease (AITD) may occur in patients after hematopoietic stem cell transplantation (HSCT). In all, 10 cases of AITD (seven allogeneic and three autologous HSCT) were diagnosed among 721 HSCT recipients, including two patients with sequential hyper- and hypothyroidism. The 5-year actuarial rates for AITD after allogeneic and autologous HSCT were 2.9 and 4%, respectively. Significant risk factors included HSCT for chronic myeloid leukemia, the HLA B46 and DR9 loci and the A2B46DR9 haplotype, while female donors showed trend to significance. On multivariate analysis, only female donors and HLA DR9 remained significant. For autologous HSCT, the associations with HLA B46 and DR9 were also significant. Only three donors had a family history of AITD. A review of other reported cases confirmed the predominance of female donors, although the other associations including graft-versus-host disease, familial AITD and other autoimmune phenomena might be related to reporting bias. Since the actuarial incidence of AITD from female donors with predisposing HLA alleles may be over 30%, susceptible recipients should be carefully monitored. Owing to the small number of reported cases and different HLA associations with AITD in different populations, our observations await confirmatory data from other registries.

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References

  1. Lister J, Messner H, Keystone E et al. Autoantibody analysis of patients with graft versus host disease. J Clin Lab Immunol 1987; 24: 19–23.

    CAS  Google Scholar 

  2. Sherer Y, Shoenfeld Y . Autoimmune diseases and autoimmunity post-bone marrow transplantation. Bone Marrow Transplant 1998; 22: 873–881.

    Article  CAS  Google Scholar 

  3. Au WY, Hawkins BR, Lie AKW et al. Association of the HLA A2-B46-DR9 haplotype with autoimmune thyroid dysfunction after bone marrow transplantation in Chinese patients. Br J Haematol 2001; 115: 660–663.

    Article  CAS  Google Scholar 

  4. Carlson K, Lonnerholm G, Smedmyr B et al. Thyroid function after autologous bone marrow transplantation. Bone Marrow Transplant 1992; 10: 123–127.

    CAS  PubMed  Google Scholar 

  5. Toubert ME, Socie G, Gluckman E et al. Short- and long-term follow-up of thyroid dysfunction after allogeneic bone marrow transplantation without the use of preparative total body irradiation. Br J Haematol 1997; 98: 453–457.

    Article  CAS  Google Scholar 

  6. Al-Fiar FZ, Colwill R, Lipton JH et al. Abnormal thyroid stimulating hormone (TSH) levels in adults following allogeneic bone marrow transplants. Bone Marrow Transplant 1997; 19: 1019–1022.

    Article  CAS  Google Scholar 

  7. Kami M, Tanaka Y, Chiba S et al. Thyroid function after bone marrow transplantation: possible association between immune-mediated thyrotoxicosis and hypothyroidism. Transplantation 2001; 71: 406–411.

    Article  CAS  Google Scholar 

  8. Jacobson DL, Gange SJ, Rose NR, Graham NM . Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol 1997; 84: 223–243.

    Article  CAS  Google Scholar 

  9. Kawa A, Nakamura S, Nakazawa M et al. HLA-BW35 and B5 in Japanese patients with Graves’ disease. Acta Endocrinol (Copenh) 1977; 86: 754–757.

    Article  CAS  Google Scholar 

  10. Naito S, Sasaki H, Arakawa K . Japanese Graves’ disease: association with HLA-Bw46. Endocrinol Jpn 1987; 34: 685–688.

    Article  CAS  Google Scholar 

  11. Hawkins BR, Serjeantson SW, Higgins DA . Distribution and co-occurrence of MHC class I, II, and III markers in southern Chinese: implications for autoimmune disease. Dis Markers 1988; 6: 237–245.

    CAS  PubMed  Google Scholar 

  12. Parkman R, Weinberg KI . Immunological reconstitution following bone marrow transplantation. Immunol Rev 1997; 157: 73–78.

    Article  CAS  Google Scholar 

  13. Paydas S, Sahin B, Hazar B, Yavuz S . The association of thyrotoxicosis and chronic lymphoproliferative disorders. Leukemia Lymphoma 2000; 38: 131–135.

    Article  CAS  Google Scholar 

  14. Hawkins BR, Ma JT, Lam KS et al. Association of HLA antigens with thyrotoxic Graves’ disease and periodic paralysis in Hong Kong Chinese. Clin Endocrinol Oxf 1985; 23: 245–252.

    Article  CAS  Google Scholar 

  15. Hawkins BR, Lam KS, Ma JT et al. Strong association between HLA DRw9 and Hashimoto's thyroiditis in southern Chinese. Acta Endocrinol (Copenh) 1987; 114: 543–546.

    Article  CAS  Google Scholar 

  16. Mulligan SP, Joshua DE, Joasoo A, Kronenberg H . Autoimmune hyperthyroidism associated with chronic graft-versus-host disease. Transplantation 1987; 44: 463–464.

    Article  CAS  Google Scholar 

  17. Wyatt DT, Lum LG, Casper J et al. Autoimmune thyroiditis after bone marrow transplantation. Bone Marrow Transplant 1990; 5: 357–361.

    CAS  Google Scholar 

  18. Aldouri MA, Ruggier R, Epstein O, Prentice HG . Adoptive transfer of hyperthyroidism and autoimmune thyroiditis following allogeneic bone marrow transplantation for chronic myeloid leukaemia. Br J Haematol 1990; 74: 118–119.

    Article  CAS  Google Scholar 

  19. Holland FJ, McConnon JK, Volpe R, Saunders EF . Concordant Graves’ disease after bone marrow transplantation: implications for pathogenesis. J Clin Endocrinol Metab 1991; 72: 837–840.

    Article  CAS  Google Scholar 

  20. Ichihashi T, Yoshida H, Kiyoi H et al. Development of hyperthyroidism in donor and recipient after allogeneic bone marrow transplantation. Bone Marrow Transplant 1992; 10: 397–398.

    CAS  Google Scholar 

  21. Vialettes B, Maraninchi D, San Marco MP et al. Autoimmune polyendocrine failure – type 1 (insulin-dependent) diabetes mellitus and hypothyroidism – after allogeneic bone marrow transplantation in a patient with lymphoblastic leukaemia. Diabetologia 1993; 36: 541–546.

    Article  CAS  Google Scholar 

  22. Thomson JA, Wilson RM, Franklin IM . Transmission of thyrotoxicosis of autoimmune type by sibling allogeneic bone marrow transplant. Eur J Endocrinol 1995; 133: 564–566.

    Article  CAS  Google Scholar 

  23. Karthaus M, Gabrysiak T, Brabant G et al. Immune thyroiditis after transplantation of allogeneic CD34+ selected peripheral blood cells. Bone Marrow Transplant 1997; 20: 697–699.

    Article  CAS  Google Scholar 

  24. Kishimoto Y, Yamamoto Y, Ito T et al. Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation. Bone Marrow Transplant 1997; 19: 1041–1043.

    Article  CAS  Google Scholar 

  25. Berisso GA, van Lint MT, Bacigalupo A, Marmont AM . Adoptive autoimmune hyperthyroidism following allogeneic stem cell transplantation from an HLA-identical sibling with Graves’ disease. Bone Marrow Transplant 1999; 23: 1091–1092.

    Article  CAS  Google Scholar 

  26. Takeshita A, Shinjo K, Ohno R . Graves disease after bone marrow transplantation. Ann Intern Med 1999; 131: 157.

    Article  CAS  Google Scholar 

  27. Marazuela M, Steegman JL . Transfer of autoimmune hypothyroidism following bone marrow transplantation from a donor with Graves’ disease. Bone Marrow Transplant 2000; 26: 1217–1220.

    Article  CAS  Google Scholar 

  28. Hsiao LT, Liu JH, Yen CC et al. Relapse of Graves’ disease after successful allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 28: 1151–1153.

    Article  CAS  Google Scholar 

  29. Lee WY, Oh ES, Min CK et al. Changes in autoimmune thyroid disease following allogeneic bone marrow transplantation. Bone Marrow Transplant 2001; 28: 63–66.

    Article  CAS  Google Scholar 

  30. Obuobie K, Al-Sabah A, Lazarus JH . Subacute thyroiditis in an immunosuppressed patient. J Endocrinol Invest 2002; 25: 169–171.

    Article  CAS  Google Scholar 

  31. Olivares JL, Ramos FJ, Olive T et al. Autoimmune thyroiditis after bone marrow transplantation in a boy with Wiskott–Aldrich syndrome. J Pediatr Hematol Oncol 2002; 24: 772–776.

    Article  Google Scholar 

  32. Law A, Rifkind J, Rosen F, Lipton JH . Hyperthyroidism six years post-BMT for acute myeloblastic leukemia in a patient on long-term lithium therapy for bipolar affective disorder. Leukemia Lymphoma 2004; 45: 807–809.

    Article  Google Scholar 

  33. Au WY, Lie AK, Ma SK et al. Tyrosine kinase inhibitor STI571 in the treatment of Philadelphia chromosome-positive leukaemia failing myeloablative stem cell transplantation. Bone Marrow Transplant 2002; 30: 453–457.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong

    W Y Au, A K W Lie, A W C Kung, R Liang & Y L Kwong

  2. Department of Pathology, Queen Mary Hospital, University of Hong Kong, Hong Kong

    B R Hawkins

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  1. W Y Au
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  2. A K W Lie
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  3. A W C Kung
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  4. R Liang
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  5. B R Hawkins
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Correspondence to W Y Au.

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Au, W., Lie, A., Kung, A. et al. Autoimmune thyroid dysfunction after hematopoietic stem cell transplantation. Bone Marrow Transplant 35, 383–388 (2005). https://doi.org/10.1038/sj.bmt.1704766

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