LONG-TERM OUTCOME OF AUTOIMMUNE-DISEASE FOLLOWING ALLOGENEIC BONE-MARROW TRANSPLANTATION

Objective. To investigate the long-term outcome of autoimmune disease following allogeneic bone marrow transplantation (BMT), and its relati onship to hemopoietic chimerism. Methods. Three previously described p atients with rheumatoid arthritis (RA) who underwent allogeneic BMT fo r therapy-related severe aplastic anemia and 1 new patient with psoria sis who received BMT for chronic myeloid leukemia (CML) were followed up, Molecular studies were performed to assess hemopoietic and immune reconstitution in 3 cases. Results. In 2 of the RA patients, the RA re mained in remission without treatment, with nonprogressive disease, 11 and 13 years after BMT. The third patient with RA had a relapse 2 yea rs after BMT, although the previously aggressive disease subsequently ran an attenuated course with treatment-free remission for the last 11 years. Comparison with other cases of RA suggests that graft-versus-h ost disease may influence the longterm outcome, perhaps through ongoin g inhibition of the immune system, In the patient with psoriasis, BMT was followed by remission, but the psoriatic rash recurred and arthrop athy developed 12 months later. The psoriasis and arthropathy remained active 4.5 years post-BMT, although the CML remained in remission. Mo lecular studies in the 2 patients whose RA remained in continued remis sion and in the patient with psoriasis that relapsed confirmed complet e donor hemopoietic reconstitution. Conclusion. Long-term followup of autoimmune disease after allogeneic transplantation confirmed cure of the autoimmune disease in some, but eventual relapse in others, The oc currence of relapse despite complete donor hemopoietic reconstitution is evidence for the development of de novo, as opposed to persistent, disease, and is possibly related to intrinsic susceptibility of the tr ansplanted stem cells or to host factors, There may be a relationship between remission of autoimmune disease and graft-versus-host reaction , These findings have relevance for the evolving application of stem c ell transplantation as a therapy for autoimmune diseases.