Autoimmune diseases after allogeneic stem cell transplantation: a clinician’s guide and future outlook

ABSTRACT

Introduction

Autoimmune disease (AD) may occur after allogeneic hematopoietic stem cell transplantation (HSCT). The autoimmune mechanism seems to be related to an imbalance of the immune regulation effect of T-regulatory lymphocytes on autoreactive T-lymphocytes.

Areas covered

ADs include hematological ADs (HADs) and nonhematologic ADs (NHADs) involving organs such as thyroid, peripheral and central nervous system, skin, liver, connective tissue, gastrointestinal tract, and kidney. To identify the risk factors for ADs, to report their clinical characteristics, and to discuss new approaches represent the areas covered in this review.

Expert opinion

Some risk factors for HAD and NHAD are common and include nonmalignant diseases, young age, cord blood as a stem cell source, conditioning regimens without total body irradiation, alemtuzumab, antithymocyte globulin, T-cell-depleted transplant, some viral infection, mixed chimerism, and chronic Graft versus Host Disease. In NHADs, the detection of autoantibodies is more frequent and the transfer of autoimmunity from the donor to the recipient represents the pathogenetic mechanism responsible for these complications. New therapeutic approaches such as bortezomib, daratumumab, sirolimus, eculizumab, and eltrombopag appear to be promising in terms of better efficacy and reduced toxicity compared to traditional therapies. New horizons based on personalized therapies will allow us to improve the prognosis of AD.

KEYWORDS:

• Hematological autoimmune disease
• nonhematological autoimmune disease
• risk factors
• chronic GvHD
• autoantibodies
• new therapeutic approaches

Article highlights

• HADs and NHADs are complications that may occur after allogeneic HSCT.

• Patients, transplant, and post-transplant risk factors should be considered when an AD occurs.

• Transfer of immunity from the donor to the recipient is more frequent in NHAD.

• New therapeutic approaches including biological therapy and new immunosuppressive drugs with regulatory activity on T-lymphocytes lead to better response to treatment and improved the outcome

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers of this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.