Multiple autoimmune events after autologous bone marrow transplantation.
A 36-year-old woman with RAEB-t and severe bone marrow fibrosis undergoing autologous BMT, developed a histologically documented GVHD-like skin rash. Thereafter, autoimmune thyroiditis, autoimmune thrombocytopenic purpura and autoimmune hemolytic anemia and a lupus anti-coagulant (LAC) were diagnosed. The patient is still alive, symptom-free and in first complete remission (CR); however, all of the autoantibodies are still detectable, with the exception being the anti-erythrocyte antibody. The most outstanding feature of the present case is the polymorphism of the autoimmune events, in the absence of a coexisting systemic autoimmune disease. This patient has achieved long-term disease-free survival (DFS) in first CR despite high-risk MDS and the repeated immunosuppressant therapy required because of the complications described above; a GVL reaction somewhat similar to the autoimmune events may have contributed towards maintaining disease control.
Lambertenghi-Deliliers
G L
GL
Centro Trapianti di Midollo, Ospedale Maggiore IRCCS, Milan, Italy.
Annaloro
C
C
Della Volpe
A
A
Oriani
A
A
Pozzoli
E
E
Soligo
D
D
D000328:Adult; D000754:Anemia, Refractory, with Excess of Blasts / Q000276:immunology / Q000628:therapy*; D001327:Autoimmune Diseases / Q000209:etiology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D014182:Transplantation, Autologous