title: Clinically demonstrable anti-autoimmunity mediated by allogeneic immune cells favorably affects outcome after stem cell transplantation in human autoimmune diseases.
abstract: To determine the role of allogeneic, autologous and syngeneic hemopoietic stem cell transplantation (SCTx) as a treatment for severe autoimmune disease (AID) we performed a literature search employing Medline, Cancer Lit and abstract books for reports on transplants for blood disorders and a concomitant AID. All reviews, case reports and abstracts available between June 1977 and September 2001 were used and attempts made to update them by e-mail by the corresponding authors. Disease-free survival (DFS) after allogeneic SCTx for 23 patients with severe aplastic anemia was 78% at 16 years and survival in unmaintained remission of concomitant AID was 64% at 13 years. DFS after allogeneic SCTx for 24 patients with hematologic malignancies was 87% at 15 years and survival in unmaintained remission for concomitant AID was 70% at 11 years. DFS after autologous SCTx for 24 patients with hematologic malignancies was 48% at 6 years and survival in unmaintained remission for concomitant AID was 29% at 3 years. Among 30 patients given allogeneic SCTx 19 developed graft-versus-host disease (GVHD) and 11 did not. Upon clinically justified discontinuation of all immunosuppressive therapy, 3/11 patients without GVHD relapsed with their concomitant AID (freedom of AID-relapse 69% at 9 years), whereas none of 19 patients with GVHD did so (log rank: P = 0.0135). Freedom of AID-relapse was superior after allo SCTx compared to autologous SCTx (89% at 18 years vs 38% at 5 years; log rank: P = 0.0002). Our data suggest that a graft-versus-autoimmunity effect after allogeneic hemopoietic SCTx mediates elimination of autoimmunity.
authors.affiliation: 2nd Department of Internal Medicine, Donauspital, and Ludwig Boltzmann Institute for Stem Cell Transplantation, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Hinterberger
authors.forename: M
authors.initials: M
authors.lastname: Hinterberger-Fischer
authors.forename: A
authors.initials: A
authors.lastname: Marmont
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications / Q000401:mortality; D001327:Autoimmune Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015551:Autoimmunity / Q000276:immunology; D002648:Child; D003625:Data Collection; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007107:Immune System / Q000166:cytology / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome