Condition
- Combined guidance on Multiple Sclerosis/Systemic lupus erythematosus (SLE)/ Inflammatory arthritis (including rheumatoid arthritis)/Systemic scleroderma/CREST/Granulomatosis with Polyangiitis /Goodpasture syndrome
- Sarcoidosis - SPECIFIC GUIDANCE, SEE BELOW
- Guillain-Barre syndrome - SPECIFIC GUIDANCE, SEE BELOW
- Immune thrombocytopenia - SPECIFIC GUIDANCE, SEE BELOW
Combined guidance on Multiple Sclerosis/Systemic lupus erythematosus (SLE)/ Inflammatory arthritis (including rheumatoid arthritis)/Systemic scleroderma/CREST/Granulomatosis with Polyangiitis /Goodpasture syndrome
Defer at any stage due to donor/recipient risk.
GUIDANCE FOR SARCOIDOSIS
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation):
Accept as marrow only if one episode and complete resolution at physician discretion
Guidance at CT/WORK-UP:
- Accept as marrow only if one episode if nodal disease only and complete resolution at physician discretion. Inform transplant centre of diagnosis.
Justification for guidance:
- Recipient safety: Sarcoidosis is a multisystem disease of likely autoimmune origin 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.
GUIDANCE FOR GUILLAIN BARRE
Guidance at RECRUITMENT: Accept for BM only if single episode with full recovery
Guidance at CT/WU:
- BM only if full recovery, with no recurrence of symptoms for over 12 months. Inform TC of diagnosis
Justification for guidance:
- Recipient safety: Guillain Barré 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.
GUIDANCE FOR IMMUNE THROMBOCYTOPENIA
Guidance at RECRUITMENT: Acceptable for BM only If single episode of ITP as a child (<16y) with complete resolution.
Guidance at CT/WU:
- Childhood disease
Acceptable for BM only If single episode of ITP as a child (<16y) with complete resolution. - Adult disease
Defer - Inform TC of the diagnosis in all cases
References
Angel Korman A, Leiba A, Edel Y, Rapoport V, Tobar A, Leiba M. G-CSF-induced ANCA associated glomerulonephritis in the presence of silent membranous "full house nephropathy" in an altruistic bone marrow donor. Ren Fail. 2022 Dec;44(1):1498-1500. doi: 10.1080/0886022X.2022.2115380. PMID: 36000895; PMCID: PMC9415626.
Uemura, Y., Oshima, K., Fuseya, A. et al. Aortitis after administration of pegfilgrastim to a healthy donor for peripheral blood stem cell collection. Int J Hematol (2023). https://doi.org/10.1007/s12185-023-03649-0
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.