Clinical Significance of Autoantibody Expression in Allogeneic Stem Cell Recipients.

Some allogeneic stem cell recipients manifest autoimmune disease-like symptoms associated with the occurrence of various autoantibodies. We studied the association of autoantibodies with chronic graft-versus-host disease (cGVHD) and survival in allogeneic stem cell recipients. From Nov. 2001 to Mar. 2008, 121 patients with hematological diseases who had survived at least 3 months after allogeneic stem cell transplantation (SCT) were enrolled in the current study. Forty-seven patients (38.8%) expressed at least one of various autoantibodies after allogeneic SCT. ANA was expressed most commonly in recipients (n=22, 18.2%). Anti-dsDNA antibody was positive in 7 (5.8%), anti-Sm antibody in 6 (5%), rheumatoid factor (RF) in 17 (14.0%), and positive Coombs test in 12 (9.9%). The FANA pattern revealed 11 nucleolar, 6 speckled, and others (n=5). Positive rate of autoantibody was higher in patients with cGVHD (47.8 vs. 27.8%; p=0.025) and in patients with extensive cGVHD (62.5 vs. 27.2%; p<0.001). The expression of autoantibodies had a statistical correlation to specific organ involvement of cGVHD: ANA to sicca syndrome (p=0.010), anti-Sm antibody to hepatic GVHD (p=0.003), and RF to sicca syndrome (p=0.039) and musculoskeletal GVHD (p=0.026). The 5-year survival of autoantibody-positive patients was 63.8% and that of negative patients was 47.9% (p=0.003). The incidence of underlying disease relapse was lower in autoantibody-positive patients (20.2% vs. 39.3%; p=0.011). However, GVHD-specific survival was not related with autoantibody expression. Advanced age group (p=0.005, OR=0.246), unrelated donor (p=0.005, OR=0.218), and the presence of acute GVHD (p=0.029, OR=0.315) were significantly associated with a lower incidence of autoantibody expression. In conclusion, the expression of autoantibodies after allogeneic SCT was related with cGVHD. Patients expressing autoantibodies had a better survival and low incidence of underlying disease relapse.