New autoimmune diseases after cord blood transplantation: a retrospective study of EUROCORD and the Autoimmune Disease Working Party of the European Group for Blood and Marrow Transplantation

• Published in: Blood Vol. 121; no. 6; pp. 1059 - 1064
• Main Authors: Daikeler, Thomas, Labopin, Myriam, Ruggeri, Annalisa, Crotta, Alessandro, Abinun, Mario, Hussein, Ayad Ahmed, Carlson, Kristina, Cornillon, Jérôme, Diez-Martin, Jose L., Gandemer, Virginie, Faraci, Maura, Lindemans, Caroline, O'Meara, Anne, Mialou, Valerie, Renard, Marleen, Sedlacek, Petr, Sirvent, Anne, Socié, Gérard, Sora, Federica, Varotto, Stefania, Sanz, Jaime, Voswinkel, Jan, Vora, Ajay, Yesilipek, M. Akif, Herr, Andree-Laure, Gluckman, Eliane, Farge, Dominique, Rocha, Vanderson
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 07.02.2013; American Society of Hematology
• Subjects: Adolescent; Adult; Aged; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Autoimmune Diseases - drug therapy; Autoimmune Diseases - etiology; Child; Child, Preschool; Cord Blood Stem Cell Transplantation - adverse effects; Cyclosporine - therapeutic use; Female; Follow-Up Studies; Genetics; Humans; Immunologic Factors - therapeutic use; Immunosuppressive Agents - therapeutic use; Infant; Life Sciences; Male; Middle Aged; Multivariate Analysis; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Retrospective Studies; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; Rituximab; Steroids - therapeutic use; Survival Analysis; Young Adult; Immunologic Factors; Multivariate Analysis; Immunosuppressive Agents; Outcome Assessment (Health Care); Follow-Up Studies; Humans; Middle Aged; Antibodies; Infant; Male; Cyclosporine; Young Adult; Female; Adult; Retrospective Studies; Monoclonal; Child; Risk Assessment; Risk Factors; Preschool; Cord Blood Stem Cell Transplantation; Autoimmune Diseases; Survival Analysis; Adolescent; Aged; Murine-Derived; Steroids
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2012-07-445965

To describe the incidence, risk factors, and treatment of autoimmune diseases (ADs) occurring after cord blood transplantation (CBT), we analyzed both CBT recipients reported to EUROCORD who had developed at least 1 new AD and those who had not. Fifty-two of 726 reported patients developed at least 1 AD within 212 days (range, 27-4267) after CBT. Cumulative incidence of ADs after CBT was 5.0% ± 1% at 1 year and 6.6% ± 1% at 5 years. Patients developing ADs were younger and had more nonmalignant diseases (P < .001). ADs target hematopoietic (autoimmune hemolytic anemia, n = 20; Evans syndrome, n = 9; autoimmune thrombocytopenia, n = 11; and immune neutropenia, n = 1) and other tissues (thyroiditis, n = 3; psoriasis, n = 2; Graves disease, n = 1; membranous glomerulonephritis, n = 2; rheumatoid arthritis, n = 1; ulcerative colitis, n = 1; and systemic lupus erythematosus, n = 1). Four patients developed 2 ADs (3 cases of immune thrombocytopenia followed by autoimmune hemolytic anemia and 1 Evans syndrome with rheumatoid arthritis). By multivariate analysis, the main risk factor for developing an AD was nonmalignant disease as an indication for CBT (P = .0001). Hematologic ADs were most often treated with steroids, rituximab, and cyclosporine. With a median follow-up of 26 months (range, 2-91), 6 of 52 patients died as a consequence of ADs. We conclude that CBT may be followed by potentially life-threatening, mainly hematologic ADs. •Autoimmune diseases do occur after CBT in approximately 5% of patients.•Of these, AIHA or ITP were observed the most often and were treated with prednisone, CSA, and RTX.