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

Bone Marrow Transplantation volume 56, pages 1509–1517 (2021)Cite this article

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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.

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Fig. 1: Schematic T and B cell immune reconstitution in months after autologous HSCT for autoimmune disease.

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Authors and Affiliations

  1. Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Richard K. Burt, Xiaoqiang Han & Kathleen Quigley

  2. Neuroimmunology and Immunotherapy, Department of Brain Sciences, Imperial College London, London, UK

    Paolo A. Muraro

  3. Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), IRSL, EA-3518, Université de Paris, MATHEC, Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France, Filière FAI2R, Hôpital St-Louis, AP-HP, Paris, France

    Dominique Farge

  4. Divisão de Imunologia Clínica, Departamento de Clínica Médica, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil

    Maria Carolina Oliveira

  5. Department of Haematology, Sheffield Teaching Hospitals, NHS Foundation Trust and the University of Sheffield, Sheffield, UK

    John A. Snowden

  6. Department of Hematology, Careggi University Hospital, Florence, Italy

    Riccardo Saccardi

  7. Department of Microbiology, Immunology and Parasitology DMIP Federal University of São Paulo UNIFESP, São Paulo, Brasil

    Valquiria Bueno

  8. Department of Microbiology and Immunology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA

    Daniela Frasca

  9. The A.A. Maximov Department of Hematology and Cellular Therapy, National Pirogov Medical Surgical Center, Moscow, Russian Federation

    Denis Fedorenko

  10. Department of Neurology, Uppsala University, Uppsala, Sweden

    Joachim Burman

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  1. Richard K. Burt
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Correspondence to Richard K. Burt.

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Conflict of interest

Professor John A Snowden declares honoraria for an advisory board from MEDAC, and as an IDMC member for a trial supported by Kiadis Pharma, all outside the submitted work. Professor Paolo A. Muraro reports no conflict of interest. He discloses travel support and speaker honoraria from unrestricted educational activities organized by Novartis, Bayer HealthCare, Bayer Pharma, Biogen Idec, Merck-Serono and Sanofi Aventis. He also discloses consulting to Magenta Therapeutics and Jasper Therapeutics. All the other authors have nothing to declare.

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Burt, R.K., Muraro, P.A., Farge, D. et al. New autoimmune diseases after autologous hematopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplant 56, 1509–1517 (2021). https://doi.org/10.1038/s41409-021-01277-y

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