1
|
Faraci M, Dell'Orso G, Giardino S, Pierri F. Autoimmune diseases after allogeneic stem cell transplantation: a clinician's guide and future outlook. Expert Rev Clin Immunol 2022; 18:1-14. [PMID: 35500169 DOI: 10.1080/1744666x.2022.2072299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Autoimmune disease (AD) may occur after allogeneic hematopoietic stem cell transplantation (HSCT). The autoimmune mechanism seems to be related to an imbalance of the immune regulation effect of T-regulatory lymphocytes on autoreactive T-lymphocytes. AREAS COVERED ADs include hematological ADs (HADs) and nonhematologic ADs (NHADs) involving organs such as thyroid, peripheral and central nervous system, skin, liver, connective tissue, gastrointestinal tract, and kidney. To identify the risk factors for ADs, to report their clinical characteristics, and to discuss new approaches represent the areas covered in this review. EXPERT OPINION Some risk factors for HAD and NHAD are common and include nonmalignant diseases, young age, cord blood as a stem cell source, conditioning regimens without total body irradiation, alemtuzumab, antithymocyte globulin, T-cell-depleted transplant, some viral infection, mixed chimerism, and chronic Graft versus Host Disease. In NHADs, the detection of autoantibodies is more frequent and the transfer of autoimmunity from the donor to the recipient represents the pathogenetic mechanism responsible for these complications. New therapeutic approaches such as bortezomib, daratumumab, sirolimus, eculizumab, and eltrombopag appear to be promising in terms of better efficacy and reduced toxicity compared to traditional therapies. New horizons based on personalized therapies will allow us to improve the prognosis of AD.
Collapse
Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Gianluca Dell'Orso
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Stefano Giardino
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| | - Filomena Pierri
- Hematopoietic Stem Cell Unit, Department of Hematology-Oncology, IRCSS Istituto G. Gaslini I Istituto GGaslini, Genova, Italy
| |
Collapse
|
2
|
Delbos F, Blouin L, Bruno B, Crocchiolo R, Desoutter J, Detrait M, Nguyen-Lejarre KT, Giannoli C, Lemarié C, Renac V, Yakoub-Agha I, Dubois V. [Relevance of antibodies in hematopoietic stem cell transplantation: Antibodies anti-HLA, anti-platelets, anti-granulocytes, anti-erythrocytes and anti-MICA. Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2020; 107:S159-S169. [PMID: 32540096 DOI: 10.1016/j.bulcan.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
The presence of allo-antibodies in the serum of a recipient awaiting hematopoietic stem cell transplantation (HSCT) may have an impact on transfusion efficiency and/or donor choice, especially in the absence of an identical sibling donor. Prior to transplantation, donor specific anti-HLA (Human Leukocyte Antigen) antibodies (DSA) have a recognized effect on transplant outcome, correlated with the increasing MFI value and with the ability of such antibody to fix the complement fraction. Anti-platelet antibodies (anti-HLA class I and anti-HPA [Human Platelet Antigen]) are better involved in transfusion inefficiency and can be responsible for refractory status. ABO incompatibilities require a specific treatment of the graft in presence of high titer to avoid hemolytic adverse effects. Investigations of these antibodies should be carried out on a regular basis in order to establish appropriate transfusion recommendation, select an alternative donor when possible or adapt the source of cells. After transplantation, in case of delayed recovery or graft rejection, long term aplasia, persistent mixed chimerism or late release, and after elimination of the main clinical causes, a biological assessment targeted on the different type of antibodies will have to be performed in order to orient towards the cause or the appropriate therapy. Further studies should be carried out to determine the impact of anti-MICA antibodies and recipient specific anti-HLA antibodies, on the outcome of the transplantation.
Collapse
Affiliation(s)
- Florent Delbos
- EFS Centre Pays de la Loire, laboratoire HLA, 34, rue Jean-Monnet, 44000 Nantes, France
| | - Laura Blouin
- CHU Pellegrin, laboratoire immunologie et immunogénétique, place Amélie-Raba-Leon, 33076 Bordeaux cedex, France
| | | | - Roberto Crocchiolo
- ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milano, Italie
| | - Judith Desoutter
- CHU Amiens Picardie, service d'hématologie biologique, secteur d'histocompatibilité, 80054 Amiens cedex 1, France
| | - Marie Detrait
- Service d'hématologie et de transplantation médullaire, CHRU de Nancy, institut Louis-Mathieu, hôpitaux de Brabois, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Khan Tien Nguyen-Lejarre
- EFS Bourgogne Franche-Comté, laboratoire d'immunogénétique, 8, rue du Dr-JFX-Girod, 25020 Besançon cedex, France
| | - Catherine Giannoli
- EFS Auvergne Rhône Alpes, laboratoire HLA/HPA, 111, rue Elisée-Reclus, 69150 Décines, France
| | - Claude Lemarié
- Institut Paoli-Calmettes, département de biologie du cancer, Marseille, France; Inserm CBT1409 centre d'investigations cliniques en biothérapie, Marseille, France
| | - Virginie Renac
- EFS Bretagne, laboratoire d'immunogénétique et histocompatibilité immunologie plaquettaire, rue Pierre-Jean-Gineste, 35000 Rennes, France
| | | | - Valérie Dubois
- EFS Auvergne Rhône Alpes, laboratoire HLA/HPA, 111, rue Elisée-Reclus, 69150 Décines, France.
| |
Collapse
|
3
|
Li Z, Rubinstein SM, Thota R, Savani M, Brissot E, Shaw BE, Majhail NS, Mohty M, Savani BN. Immune-Mediated Complications after Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1368-1375. [DOI: 10.1016/j.bbmt.2016.04.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/06/2016] [Indexed: 11/27/2022]
|
4
|
Parissiadis A, Bilger K, Laplace A, Berceanu A, Schwebel M, Froelich N, Cazenave JP, Hanau D, Tourne S, Lioure B. [Occurrence of severe, persistent thrombocytopenia following allogeneic bone marrow transplantation, attributable to anti-HPA-1 allo-immunisation of the host]. Transfus Clin Biol 2010; 17:265-8. [PMID: 20961787 DOI: 10.1016/j.tracli.2010.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/16/2010] [Indexed: 11/26/2022]
Abstract
A 56 year-old, multiparous woman suffering from a myeloproliferative syndrome, who had received multiple red blood cell and platelet transfusions, was the recipient of an allograft of peripheral blood stem cells derived from her HLA-A, B, DR, DQ and DP and ABO identical sister, following myeloablative conditioning. The persistence of severe, isolated thrombopenia resistant to platelet transfusions led to the discovery of anti-HLA class I allo-immunisation. As HLA compatible platelet transfusions did not result in satisfactory platelet increments, we then discovered the simultaneous presence of anti-HPA-1a allo-immunisation. Genotyping of the HPA-1 systems of the patient (HPA-1B/B) and her sister (HPA-1A/B) enabled us to elucidate the mechanism underlying the persistent thrombopenia and the inefficacy of transfusion. In fact, only transfusion of HPA-1B/B platelets (HLA compatible or incompatible) proved to be efficacious. To reduce the level of anti-HPA-1a antibodies, we performed plasmapheresis sessions and used an anti-CD20 monoclonal antibody. It was only on achieving total haematopoietic chimerism, through rapid interruption of the immunosuppression, that we obtained spontaneous normalisation of the platelet count. The present case emphasises the necessity, before undertaking any allograft of haematopoietic stem cells - even if the latter come from a strictly HLA identical member of the family - of performing a search for eventual anti-HPA allo-immunisation.
Collapse
Affiliation(s)
- A Parissiadis
- Laboratoire d'histocompatibilité, EFS-Alsace, 10, rue Spielmann, 67065 Strasbourg, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Bhatti FA, Uddin M, Ahmed A, Bugert P. Human platelet antigen polymorphisms (HPA-1, -2, -3, -4, -5 and -15) in major ethnic groups of Pakistan. Transfus Med 2010; 20:78-87. [DOI: 10.1111/j.1365-3148.2009.00982.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
6
|
Platelet recovery and transfusion needs after reduced intensity conditioning allogeneic peripheral blood stem cell transplantation. Exp Hematol 2010; 38:55-60. [DOI: 10.1016/j.exphem.2009.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/29/2009] [Accepted: 10/01/2009] [Indexed: 11/20/2022]
|
7
|
Lucas G, Culliford S, Green F, Sidra G, Calvert A, Green A, Harrison P, Harvey J, Allen D, Smillie D, Masurekar A, Marks D, Russell N, Massey E. Recipient-derived HPA-1a antibodies: a cause of prolonged thrombocytopenia after unrelated donor stem cell transplantation. Transfusion 2009; 50:334-9. [PMID: 19874563 DOI: 10.1111/j.1537-2995.2009.02448.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with human platelet antigen (HPA) specific antibodies in cases of neonatal alloimmune thrombocytopenia and platelet (PLT) refractoriness derive clinical benefit from the use of HPA-selected PLTs. STUDY DESIGN AND METHODS This study describes three patients with underlying diagnoses of acute myeloid leukemia, chronic lymphocytic leukemia, and myelodysplasia, respectively, who underwent allogeneic bone marrow transplantation (BMT) with unrelated donors matched at the HLA-A, B, C, Dr, and DQ loci but who failed to achieve an adequate PLT count. Investigation using PLT immunofluorescence test, monoclonal antibody immobilization of PLT antigens assay, and genotyping revealed the presence of recipient-derived HPA-1a antibodies. RESULTS In two patients, anti-HPA-1a was detected post-BMT and in the third patient, anti-HPA-1a was detected during pre-BMT chemotherapy. Despite apparent 100% engraftment of donor cells, the patients' PLT counts failed to recover 9-10 months posttransplant. The patients remained PLT-transfusion dependent and failed to achieve satisfactory increments following random donor or HLA-matched PLT transfusions. After the identification of HPA-1a antibodies, the patients were supported by HPA-1a(-) PLTs and satisfactory posttransfusion PLT increments were obtained. These cases illustrate that HPA-1a antibodies may remain detectable for 10 months following apparently successful donor engraftment and the disappearance of recipient-derived HLA antibodies. The prolonged persistence of recipient-derived PLT-specific antibodies following BMT has to our knowledge not been described previously. CONCLUSION HPA-1a antibodies were associated with protracted PLT-transfusion dependence and significant hemorrhagic complications. Appropriate and timely laboratory investigation for HPA-specific antibodies followed by transfusion support with HPA-selected PLTs provided the cornerstone of the hemostatic management in these cases.
Collapse
Affiliation(s)
- Geoff Lucas
- Histocompatibility& Immunogenetics, NHS Blood and Transplant, Northway, Bristol, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Vassallo RR. New paradigms in the management of alloimmune refractoriness to platelet transfusions. Curr Opin Hematol 2007; 14:655-63. [PMID: 17898571 DOI: 10.1097/moh.0b013e3282eec526] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Following transfusion or pregnancy, a significant number of patients develop antibodies to class I human leukocyte antigen. Some will exhibit platelet transfusion refractoriness, defined as inappropriately low platelet count increments after two or more consecutive transfusions. Unfortunately, failure of at least two products is required before an immunologic work-up is undertaken. Among those diagnosed with immune refractoriness, there is no standard method for identifying platelet products likely to be effective. RECENT FINDINGS Recent advances in detection and identification of human leukocyte antigen antibody may permit pretransfusion screening of selected patients and provide guidance in choosing the optimal product. An approach more like that for red cell alloimmunized patients, in which one provides products guided solely by the antibody profile, is preferable to selection based on educated guesswork when human leukocyte antigen identical units are unavailable, and offers some advantages over platelet crossmatching. SUMMARY This review presents a literature-based algorithm with which to approach the management of platelet refractory individuals, focusing on newer technology to maximize the post-transfusion yield of matched units. Strategies are presented that allow selection of more effective products for difficult, broadly alloimmunized individuals, including patients who have developed antibodies to human platelet antigens.
Collapse
Affiliation(s)
- Ralph R Vassallo
- University of Pennsylvania School of Medicine and American Red Cross Blood Services Heritage Division, Penn-Jersey Region, Philadelphia, Pennsylvania 19123, USA.
| |
Collapse
|