Single organ autoimmune disease

Condition

Single organ autoimmune disease, including:

• Alopecia areata
• Hyperthyroidism
• Hypothyroidism
• Pernicious anaemia
• Psoriasis
• 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.

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 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 undertaken.

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.

Condition:
Chronic autoimmune skin disorder that causes patches of skin to lose pigment or color.

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: Vitiligo is an autoimmune disease that could be transferable by allogeneic stem cell transplantation. In approximately 25% cases it is associated with another autoimmune disease. 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

Aldouri MA, Ruggier R, Epstein O, Prentice HG. Adoptive transfer of hyperthyroidism and autoimmune thyroiditis following allogeneic bone marrow transplantation for chronic myeloid leukaemia. Br J Haematol 1990; 74(1): 118-9.

Berisso GA, van Lint MT, Bacigalupo A, Marmont AM. Adoptive autoimmune hyperthyroidism following allogeneic stem cell transplantation from an HLA-identical sibling with Graves' disease. Bone Marrow Transplant 1999; 23(10): 1091-2.

Campbell-Fontaine A, Coad JE, Kovach R, Ericson SG. Adoptive transfer of vitiligo after allogeneic peripheral blood stem cell transplant. Bone Marrow Transplant 2005; 36(8): 745-6.

Gardembas-Pain M, Ifrah N, Foussard C, Boasson M, Saint Andre JP, Verret JL. Psoriasis after allogeneic bone marrow transplantation. Arch Dermatol 1990; 126(11): 1523.

Holland FJ, McConnon JK, Volpe R, Saunders EF. Concordant Graves' disease after bone marrow transplantation: implications for pathogenesis. J Clin Endocrinol Metab 1991; 72(4): 837-40.

Karthaus M, Gabrysiak T, Brabant G, Prahst A, Link H, Soudah B et al. Immune thyroiditis after transplantation of allogeneic CD34+ selected peripheral blood cells. Bone Marrow Transplant 1997; 20(8): 697-9.

Kishimoto Y, Yamamoto Y, Ito T, Matsumoto N, Ichiyoshi H, Katsurada T et al. Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation. Bone Marrow Transplant 1997; 19(10): 1041-3.

Marazuela M, Steegman JL. Transfer of autoimmune hypothyroidism following bone marrow transplantation from a donor with Graves' disease. Bone Marrow Transplant 2000; 26(11): 1217-20.

Olivares JL, Ramos FJ, Olive T, Fillat C, Bueno M. Autoimmune thyroiditis after bone marrow transplantation in a boy with Wiskott-Aldrich syndrome. J Pediatr Hematol Oncol 2002; 24(9): 772-6.

Snowden JA, Heaton DC. Development of psoriasis after syngeneic bone marrow transplant from psoriatic donor: further evidence for adoptive autoimmunity. Br J Dermatol 1997; 137(1): 130-2.

Thomson JA, Wilson RM, Franklin IM. Transmission of thyrotoxicosis of autoimmune type by sibling allogeneic bone marrow transplant. Eur J Endocrinol 1995; 133(5): 564-6.

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.