PREEXISTING AUTOIMMUNE-DISEASE IN PATIENTS WITH LONG-TERM SURVIVAL AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION

We reviewed the experience with allogeneic bone marrow transplantation (BMT) at Fred Hutchinson Cancer Research Center and affiliated Seattl e hospitals for patients with preexisting autoimmune diseases. The rev iew was limited to patients who received transplants between 1969 and 1989 from a related donor and who had at least 3 years of relapse-free survival. Of 901 evaluable patients, 11 were identified with a preexi sting autoimmune disease and 2 with diseases that were possibly autoim mune in nature. Pretransplant diseases identified in this review inclu ded rheumatoid arthritis (n = 1), discoid or systemic lupus (n = 2), i nsulin dependent Type 1 diabetes (n = 3), hyperthyroidism (n = 4), der matitis herpetiformis (n = 1), vasculitis (n = 1), and Crohn's disease (n = 1). All 13 patients survive with a median followup of 14 (range, 7-20) years after transplantation from an HLA identical sibling (n = 10), parent (n = 1) or identical twin (n = 2). Pre and post-transplant histories are presented. Variables to be considered in the assessment of any beneficial effect of BMT are discussed, including consideratio n of different patterns of activity that describe the natural history of various autoimmune diseases. Although autoimmune disease did not re cur after allogeneic BMT in these 13 patients, disease and post-transp lant variables may confound the interpretation of results from retrosp ective analysis.