Ccurrence of autoantibodies in patients developing graft versus hostdkease after allogeneicbone marrow transplant

We report the presence of autoantibodies in allogeneic bone marrow transplant recipients who develop chronic graft versus host disease (GVHD). An autoantibody screen was carried out in 12 allogeneic bone marrow transplant recipients. This included rheumatoid factor (RF), antinuclear antibody (ANA), double stranded DNA (dsDNA), antimitochondrial antibody (AMA), anti smooth muscle antibody (antiSM), antiendomysial and anti reticulin antibody, antithyroid peroxidase antibody (TPO) and extractable nuclear antibody screen (ENA). The primary underlying diagnoses were acute myeloid leukaemia 6, acute lymphoblastic leukaemia 1 and chronic myeloid leukaemia 5 patients. Ten were matched related transplants and 2 were matched unrelated transplants. Four patients received a T depleted transplant whilst 8 had an unmanipulated transplant. Seven of the 12 patients developed chronic GVHD and 6 of these (85.7%) had autoantibodies present in the serum. Three had more than one type of autoantibody present. None of the patients without chronic GVHD had positive antibodies. ANA was positive in 3, dsDNA in 4, RF in 1 and antiSM in 2 patients. The ANA pattern was nucleolar in one patient and speckled in two patients. None of the patients had positive AMA, TPO, ENA or antiendomysial/ reticulin antibodies. There was some correlation between the pattern of autoantibody positivity and the clinical chronic GVHD e.g. scleroderma-like pattern of ANA in 1 patient with scleroderma like chronic GVHD and antiSm positivity in one patient with liver chronic GVHD. Five of the six patients with positive autoantibodies had unmanipulated transplants whilst 1 had a T depleted transplant. There was some correlation between the titre of autoantibodies and the clinical severity of chronic GVHD. In summary autoantibodies were found in the majority of patients with chronic GVHD and were negative in its absence. There was some correlation with disease severity. They were commoner in patients with unmanipulated transplants. These antibodies are most likely to originate from the donor lymphocytes and perhaps should be termed alloantibodies. In conclusion, the finding of positive autoantibodies in allogeneic transplant confirms the similarity of chronic GVHD to autoimmune diseases and may prove a useful parameter in the diagnosis and treatment of chronic GVHD.