Severe or Systemic autoimmune disease, including:
Inflammatory bowel disease
Multiple sclerosis (MS)
Systemic lupus erythematosus (SLE)
Inflammatory arthritis (including rheumatoid arthritis)
Donor / recipient
QUALIFIED. Donors in remission of the above diseases who have not required systemic 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.
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.
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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.
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