title: Recurrence of autoimmune disease after autologous peripheral blood stem cell transplantation for multiple myeloma.
abstract: There have been a number of reports on the improvement of concomitant autoimmune disease (AID) after autologous hematopoietic stem cell transplantation (SCT) performed for hematologic malignancy. However, in some cases of hematologic malignancy with AID, exacerbation of AID after autologous SCT has been reported. We have treated 27 adults with multiple myeloma with single or tandem autologous SCT. After peripheral blood stem cells were collected and stored without CD34+ cell selection or T-cell depletion, all patients received melphalan (200 mg/m2) as a conditioning regimen. In 2 patients with a history of AID (one with rheumatoid arthritis [RA] and the other with bullous pemphigoid [BP]) and in 1 patient with Sjögren syndrome, AID recurred 7 to 12 months after autologous SCT. The RA and BP were in durable remission before SCT, and no Sjögren syndrome-related disease activity was clinically documented at the time of SCT. No progression of the myeloma was observed when the AIDs recurred. The patients required systemic steroid therapy for their AID, and successful control of the disease was achieved. Our experience suggests that autologous SCT with unmanipulated stem cells for myeloma is unlikely to cure preexisting AID; rather, the AID may worsen. Transplantation physicians should be aware of this possible complication.
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Isshiki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
authors.forename: Tsunenori
authors.initials: T
authors.lastname: Kakimoto
authors.forename: Chien-Kang
authors.initials: CK
authors.lastname: Chen
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Kenji
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hattori
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ikeda
mesh_terms: D000368:Aged; D018952:Antigens, CD34; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000473:pathology; D001327:Autoimmune Diseases / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000628:therapy*; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000473:pathology; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D012008:Recurrence; D012859:Sjogren's Syndrome / Q000188:drug therapy / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous
chemical_list: D018952:Antigens, CD34; D013256:Steroids; D008558:Melphalan