Condition

1. Combined guidance on Multiple Sclerosis/Systemic lupus erythematosus (SLE)/ Inflammatory arthritis (including rheumatoid arthritis)/Systemic scleroderma/CREST/Granulomatosis with Polyangiitis /Goodpasture syndrome
2. Sarcoidosis - SPECIFIC GUIDANCE, SEE BELOW
3. Guillain-Barre syndrome - SPECIFIC GUIDANCE, SEE BELOW
4. Immune thrombocytopenia - SPECIFIC GUIDANCE, SEE BELOW
5. Inflammatory bowel disease - 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

GUIDANCE FOR INFLAMMATORY BOWEL DISEASE

Guidance at RECRUITMENT: Accept

Guidance at CT/WU: Accept donors for BM only if in stable remission with complete recovery who have not required disease modifying therapy for more than one year ; Defer in case of (a history of) severe or recurrent disease. Inform transplant centre of diagnosis.

Justification for guidance:

• 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

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.