Page History

Condition

Single organ autoimmune disease, including:

Condition

Single organ autoimmune disease, including:

• Alopecia areata
• Hyperthyroidism
• HypothyroidismCoeliac disease (celiac disease, sprue)
• Pernicious anaemia
• Alopecia areataPsoriasis
• Vitiligo

Condition:
Autoimmune condition where the immune system attacks the hair follicles, causing patchy hair loss

Individuals at risk:
Donor and recipient

Guidance at CT/WU:
Accept for BM

Accept for PBSC if stable disease. Inform transplant center about diagnosis.

Inform the donor about the risk of exacerbation during consent

Defer if on systemic immunosuppression

Justification for guidance:

• Recipient safety: Alopecia areata is an autoimmune disease that could be transferable by allogeneic stem cell transplantation. The transplant physician should weigh the risk/benefits of using the specific donor on an individual basis.
• Donor safety: GCSF could exacerbate an underlying existing autoimmunity in the donor.

Condition:

Hyperthyroidism: excess production of thyroid hormone which causes an increase in the body’s metabolism. Most commonly it is caused by Graves’ disease. Other causes include toxic thyroid nodules or medications like amiodaron.

Individuals at risk:
Donor and recipient

Guidance at CT/WU:

Graves: Defer for PBSC due to risk of thyrotoxicosis and due to the fact that other organ(s)systems may be involved (eye). BM only if successfully completed radioiodine treatment or surgical treatment and stable for at least three months on thyroid replacement therapy and >6 months from diagnosis. Also consider accepting 2 years after completing block and replace therapy (eg carbimazole). Inform TC of diagnosis

Justification for guidance:

• Safety of the patient: Graves disease and Hashimoto are autoimmune diseases that could be transferable by allogeneic stem cell transplantation. The transplant physician should weigh the risk/benefits of using the specific donor on an individual basis.
• Safety of the donor: GCSF could exacerbate autoimmunity in the donor (including extra-thyroidal manifestations) or cause thyrotoxicosis in case of Grave’s disease.

Condition:

Hypothyroidism: insufficient production of thyroid hormone by the thyroid gland. In western countries the most common cause is autoimmune inflammation (Hashimoto, also seronegative / no evidence of anti-TPO). Treatment consists of daily synthetic replacement hormone (levothyroxine).

Individuals at risk:
Donor and recipient

Guidane at CT/WU:
Acceptable if stable for at least three months on thyroid replacement therapy and >6 months from diagnosis Inform TC of the diagnosis

Condition:
Autoimmune gastritis leading to vitamin B12 deficiency and anaemia.

Individuals at risk:
Donor and recipient

Guidance at CT/WU:

Accept if the donor has had at least three months of parenteral vitamin B12 therapy and the full blood count meets registry limits.

Inform transplant center of diagnosis.

Justification for guidance:

• Recipient safety: Pernicious anaemia is an autoimmune disease that could be transferable by allogeneic stem cell transplantation. The transplant physician should weigh the risk/benefits of using the specific donor on an individual basis.
• Donor safety: GCSF could exacerbate autoimmunity in the donor.

Thyroid disease (e.g.Hashimoto throiditis, Graves disease). 

Donor must not donate if:

• Malignant (cancerous);
• Any thyroid disorder under investigation;
• Graves disease (hyperthyroidism or thyrotoxicosis) within six months of treatment with radioactive iodine therapy;
• Graves disease (hyperthyroidism or thyrotoxicosis) within 2 years of completing anti-thyroid tablet therapy (e.g. carbimazole);
• Currently taking beta-blockers;

Condition:

Psoriasis is a primarily a skin condition caused by an autoimmune process. About one in ten people with psoriasis may develop join problems (psoriatic arthropathy). Sometimes the disease is treated with powerful drugs to suppress the underlying autoimmune process (e.g. MTX, biologicals, fumaric acid). This may alter the body's defence defense mechanism to infection and is an indication that the disease is severe and there may be a heightened risk of severe exacerbations as a consequence of donation. In such cases the donations should not be takenundertaken.

Donor must not donate if:

• has ever taken Etretinate (Tigason)
• less than 24 months from the last dose of Acitretin (Neotigason)
• generalized or server
• associated with arthropathy
• there is a secondary infection

If mild and only topical treatment, accept.

Justification for guidance

Individual at risk:
Donor and recipient

Guidance at CT/WU:

Accept for PBSC and BM if mild (small, isolated areas) and only topical treatment.Inform TC of diagnosis

If moderate and not on systemic treatment : BM only.

Inform the donor about the risk of exacerbation during consent.

Defer if:

Severe disease including psoriatic arthropathy, or

Unable to access BM or PBSC harvest sites due to skin disease- taking immunosuppression or biological agents (see medication page for deferral periods of specific agents)

Justification for guidance

Recipient safety: Psoriasis is likely an autoimmune disease that could be  transferable by allogeneic stem cell transplantation. The transplant physician should weigh the risk/benefits of using the specific donor on an individual basis.
Donor safety: GCSF could exacerbate autoimmunity in the donor.