Condition
Severe or Systemic autoimmune disease, including:
Inflammatory bowel disease
Multiple sclerosis (MS)
Systemic lupus erythematosus (SLE)
Inflammatory arthritis (including rheumatoid arthritis)
Scleroderma/CREST
Sarcoidosis
Guillain-Barre syndrome
Wegener granulomatosis
Goodpasture syndrome
Individual at risk
Donor / recipient
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
UNACCEPTABLEACCEPT
Guidance at CT/WORK-UP
QUALIFIED. Donors in remission of the above diseasesAccept donors for BM only if in stable remission with complete recovery who have not required
systemicdisease modifying therapy for more than one year
may be considered for donation on an individual basis, but should not receive granulocyte colony stimulating factor and thus donate by bone marrow only.Risk of adoptive transfer of disease-causing cells should be discussed with the recipient, and risks of disease activation should be discussed with the donor; Defer in case of (a history of) severe or recurrent disease. Inform transplant centre of diagnosis.
Justification for guidance
Autoimmune disease on this list can be passed by adoptive transfer of t-lymphocytes in experimental animal models, and these diseases are recapitulated in recipient animals. Donor genetic polymorphisms that predispose to inflammatory bowel disease may induce this disease in transplant recipients, and there is clinical evidence of disease transfer in donor:recipient pairs.
Donors with systemic autoimmune/inflammatory disease may be at risk for Macrophage Activation Syndrome upon administration of granulocyte colony stimulating factor.
- Recipient safety: Inflammatory bowel disease is an autoimmune disease could be transferable by allogeneic stem cell transplantation. Because the disease is not life threatening, the recipient and 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.
References
Anderlini P, Przepiorka D, Korbling M, Champlin R. Blood stem cell procurement: donor safety issues. Bone Marrow Transplant 1998; 21 Suppl 3: S35-9.
Bhagat R, Rizzieri DA, Vredenburgh JJ, Chao NJ, Folz RJ. Pulmonary sarcoidosis following stem cell transplantation: is it more than a chance occurrence? Chest 2004; 126(2): 642-4.
Lampeter EF, Homberg M, Quabeck K, Schaefer UW, Wernet P, Bertrams J et al. Transfer of insulin-dependent diabetes between HLA-identical siblings by bone marrow transplantation. Lancet 1993; 341(8855): 1243-4.
Lampeter EF, McCann SR, Kolb H. Transfer of diabetes type 1 by bone-marrow transplantation. Lancet 1998; 351(9102): 568-9.
Marmont AM. Autoimmunity and allogeneic bone marrow transplantation. Bone Marrow Transplant 1992; 9(1): 1-3.
Openshaw H, Stuve O, Antel JP, Nash R, Lund BT, Weiner LP, et al. Multiple sclerosis flares associated with recombinant granulocyte colony-stimulating factor. Neurology 2000;54(11):2147-50.
Snowden JA, Atkinson K, Kearney P, Brooks P, Biggs JC. Allogeneic bone marrow transplantation from a donor with severe active rheumatoid arthritis not resulting in adoptive transfer of disease to recipient. Bone Marrow Transplant 1997; 20(1): 71-3.
Sonwalkar SA, James RM, Ahmad T, Zhang L, Verbeke CS, Barnard DL et al. Fulminant Crohn's colitis after allogeneic stem cell transplantation. Gut 2003; 52(10): 1518-21.
Vialettes B, Maraninchi D. Transfer of insulin-dependent diabetes between HLA-identical siblings by bone marrow transplantation. Lancet 1993; 342(8864): 174.
Waters AH, Metcalfe P, Minchinton RM, Barrett AJ, James DC. Autoimmune thrombocytopenia acquired from allogeneic bone-marrow graft: compensated thrombocytopenia in bone marrow donor and recipient. Lancet 1983; 2(8364): 1430.
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