TRANSPLANTATION WITH ALLOGENIC BONE-MARROW FROM A DONOR WITH SYSTEMICLUPUS-ERYTHEMATOSUS (SLE) - SUCCESSFUL OUTCOME IN THE RECIPIENT AND INDUCTION OF AN SLE FLARE IN THE DONOR

Objective-To investigate the transfer of autoimmunity by allogenic bon e marrow transplantation. Methods-Bone marrow transplantation was perf ormed in a 43 years old man with acute myeloid leukaemia (AML) in remi ssion. The donor was his HLA identical brother who had a mild systemic lupus erythematosus (SLE). Autoantibodies, including antinuclear, ant i-C1q, and anti-cardiolipin antibodies, were measured before and after transplantation. Results-Transient mild graft versus host disease (Gv HD) developed in the recipient in the weeks following transplantation. The donor had persistently high concentrations of anti-C1q antibodies to the collagenous region of the complement component C1q. Three mont hs after transplantation the recipient developed antiC1q antibodies th at persisted for two months. No other autoantibodies and no SLE-like m anifestations appeared. Chronic GVHD started five months posttransplan t and responded to intensified immunosuppressive treatment. Three year s post-transplant the patient was in unmaintained remission. Within a few weeks after bone marrow donation the donor's disease was exacerbat ed with development of severe pulmonary alveolitis which required trea tment with cyclophosphamide.Conclusions-When bone marrow transplantati on was performed in a patient with AML with bone marrow from an HLA id entical brother who had SLE, no evidence of transfer of disease was ob tained. However, the recipient temporarily produced anti-C1q antibodie s which was a characteristic feature of the donor's SLE and was probab ly produced by the transplant. The flare of the donor's SLE might be r elated to the bone marrow tap.