To specify the incidence and risk factors for secondary autoimmune diseases (ADs) after HSCT for a primary AD, we retrospectively analyzed AD patients treated by HSCT reported to EBMT from 1995 to 2009 with at least 1 secondary AD (cases) and those without (controls). After autologous HSCT, 29 of 347 patients developed at least 1 secondary AD within 21.9 (0.6-49) months and after allogeneic HSCT, 3 of 16 patients. The observed secondaryADs included: autoimmune hemolytic anemia (n ∇ 3), acquired hemophilia (n ∇ 3), autoimmune thrombocytopenia (n ∇ 3), antiphospholipid syndrome (n ∇ 2), thyroiditis (n ∇ 12), blocking thyroid- stimulating hormone receptor antibody (n ∇ 1), Graves disease (n ∇ 2), myasthenia gravis (n ∇ 1), rheumatoid arthritis (n ∇ 2), sarcoidosis (n ∇ 2), vasculitis (n ∇ 1), psoriasis (n ∇ 1), and psoriatic arthritis (n ∇ 1). After autologous HSCT for primary AD, the cumulative incidence of secondary AD was 9.8% ±2% at 5 years. Lupus erythematosus as primary AD, and antithymocyte globulin use plus CD34+ graft selection were important risk factors for secondary AD by multivariate analysis. With a median follow-up of 6.2 (0.54-11) years after autologous HSCT, 26 of 29 patients with secondary AD were alive, 2 died during their secondary AD (antiphospholipid syndrome, hemophilia), and 1 death was HSCT-related. This European multicenter study underlines the need for careful management and follow-up for secondary AD after HSCT.
ASJC Scopus subject areas
- Cell Biology