Clinical Significance of Autoantibody Expression in Allogeneic Stem-Cell Recipients

Abstract

BACKGROUND: The occurrence of autoantibodies has been reported in allogeneic stem-cell recipients, but the association of this occurrence with chronic graft-versus-host disease (cGVHD) or survival remains uncertain. METHODS: A total of 121 consecutive patients who underwent allogeneic stem-cell transplantation from November 2001 to March 2008 and survived at least 3 months after transplantation were included in this study. RESULTS: Forty-seven patients (38.8%) expressed at least one of various autoantibodies after transplantation. Antinuclear antibody was positive in 22 patients (18.2%), antidouble stranded DNA in seven (5.8%), antismooth muscle antibody in six (5%), rheumatoid factor in 17 (14.0%), and a positive Coombs test recorded for 12 patients (9.9%). cGVHD was more commonly diagnosed in the patients with autoantibody expression (61.7% vs. 43.2%, P=0.048). The patients expressing autoantibodies had a better 5-year overall survival than those without any autoantibody expression: 70.2% and 47.9% for the autoantibody-positive and autoantibody-negative patients, respectively (P=0.002). The cumulative incidence of relapse was 21.5% and 39.3% for the autoantibody-positive and autoantibody-negative patients, respectively (P=0.023). In particular, the patients expressing autoantibodies without cGVHD had a better overall survival (100%) than the patients in the other groups: 63.1% for the autoantibody- and cGVHD-positive patients, 59.6% for the autoantibody-negative and cGVHD-positive patients, and 36.6% for the autoantibody- and cGVHD-negative patients. The multivariate analysis identified autoantibody expression as a good prognostic factor regarding survival (hazard ratio=0.378, 95% confidence interval=0.185-0.775, P=0.008). CONCLUSION: The occurrence of autoantibodies after allogeneic stem-cell transplantation was found to be related to cGVHD, and patients expressing autoantibodies had a better survival.