title: New autoimmune diseases after cord blood transplantation: a retrospective study of EUROCORD and the Autoimmune Disease Working Party of the European Group for Blood and Marrow Transplantation.
abstract: To describe the incidence, risk factors, and treatment of autoimmune diseases (ADs) occurring after cord blood transplantation (CBT), we analyzed both CBT recipients reported to EUROCORD who had developed at least 1 new AD and those who had not. Fifty-two of 726 reported patients developed at least 1 AD within 212 days (range, 27-4267) after CBT. Cumulative incidence of ADs after CBT was 5.0% +/- 1% at 1 year and 6.6% +/- 1% at 5 years. Patients developing ADs were younger and had more nonmalignant diseases (P < .001). ADs target hematopoietic (autoimmune hemolytic anemia, n = 20; Evans syndrome, n = 9; autoimmune thrombocytopenia, n = 11; and immune neutropenia, n = 1) and other tissues (thyroiditis, n = 3; psoriasis, n = 2; Graves disease, n 1; membranous glomerulonephritis, n = 2; rheumatoid arthritis, n = 1; ulcerative colitis, n = 1; and systemic lupus erythematosus, n = 1). Four patients developed 2 ADs (3 cases of immune thrombocytopenia followed by autoimmune hemolytic anemia and 1 Evans syndrome with rheumatoid arthritis). By multivariate analysis, the main risk factor for developing an AD was nonmalignant disease as an indication for CBT (P = .0001). Hematologic ADs were most often treated with steroids, rituximab, and cyclosporine. With a median follow-up of 26 months (range, 2-91), 6 of 52 patients died as a consequence of ADs. We conclude that CBT may be followed by potentially life-threatening, mainly hematologic ADs.
authors.affiliation: Eurocord, Hôpital Saint Louis Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris VII, Paris, France. tdaikeler@uhbs.ch
authors.forename: Thomas
authors.initials: T
authors.lastname: Daikeler
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crotta
authors.forename: Mario
authors.initials: M
authors.lastname: Abinun
authors.forename: Ayad Ahmed
authors.initials: AA
authors.lastname: Hussein
authors.forename: Kristina
authors.initials: K
authors.lastname: Carlson
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
authors.forename: Jose L
authors.initials: JL
authors.lastname: Diez-Martin
authors.forename: Virginie
authors.initials: V
authors.lastname: Gandemer
authors.forename: Maura
authors.initials: M
authors.lastname: Faraci
authors.forename: Caroline
authors.initials: C
authors.lastname: Lindemans
authors.forename: Anne
authors.initials: A
authors.lastname: O'Meara
authors.forename: Valerie
authors.initials: V
authors.lastname: Mialou
authors.forename: Marleen
authors.initials: M
authors.lastname: Renard
authors.forename: Petr
authors.initials: P
authors.lastname: Sedlacek
authors.forename: Anne
authors.initials: A
authors.lastname: Sirvent
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Federica
authors.initials: F
authors.lastname: Sora
authors.forename: Stefania
authors.initials: S
authors.lastname: Varotto
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.forename: Jan
authors.initials: J
authors.lastname: Voswinkel
authors.forename: Ajay
authors.initials: A
authors.lastname: Vora
authors.forename: M Akif
authors.initials: MA
authors.lastname: Yesilipek
authors.forename: Andree-Laure
authors.initials: AL
authors.lastname: Herr
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Dominique
authors.initials: D
authors.lastname: Farge
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D000069283:Rituximab; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D013256:Steroids; D000069283:Rituximab; D016572:Cyclosporine