Remission of psoriasis after allogeneic, but not autologous, hematopoietic stem-cell transplantation

doi:10.1016/j.jaad.2012.08.021

Journal of the American Academy of Dermatology

Volume 68, Issue 3, March 2013, Pages 489-492

https://doi.org/10.1016/j.jaad.2012.08.021 Get rights and content

Hematopoietic stem-cell transplantation (HSCT) has emerged as an effective immunotherapy for several severe autoimmune diseases. A comprehensive search of the existing literature was performed for patients with psoriasis and HSCT. Nineteen patients have been reported to have psoriasis resolution after allogeneic or autologous HSCT. In the allogeneic setting, 10 of 13 were noted to have durable remission of their psoriasis with a mean follow-up of 49 months. Two cases that did reoccur were only transient. Six patients underwent autologous transplantation. Of these, 5 of 6 developed a recurrence of their psoriasis within 2 years. Based on a limited number of patients, psoriasis is likely to remit after allogeneic HSCT, but it is likely to recur after autologous HSCT.

Section snippets

Cases of psoriasis resolution

A comprehensive search using the PubMed search engine was conducted in the English language to identify all previously reported cases of psoriasis that resolved after HSCT. The terms “psoriasis,” “hematopoietic stem cell transplantation,” and “bone marrow transplant,” or different combinations of these words, were used. Seventeen cases were initially found. The bibliographies of previously reported cases were cross-checked, allowing for the addition of 1 case report published in the Japanese

Discussion

Allogeneic HSCT is potentially curative for autoimmune diseases, but is associated with higher rates of transplantation-related mortality than autologous HSCT. Consequently, autologous HSCT is the investigational treatment for refractory autoimmune diseases. In large studies of autologous HSCT for autoimmune disease, the transplantation-related mortality rate ranged from 5% to 12%.17, 18, 19 In these cases, the genetic background was unchanged and the same potential T-cell receptor diversity

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Cited by (20)

Disease-specific corona mediated co-delivery of MTX and siRNA-TNFα by a polypeptide nanoplatform with antigen-scavenging functions in psoriasis
2023, Journal of Controlled Release
Psoriatic self-antigen LL37 has the ability to stimulate skin-homing T lymphocytes, which is the constitutive factor for the relapse of psoriasis. The local inflammatory modulation in psoriatic skin is not sufficient for the restoration of immune homeostasis. In this study, we found the expression levels of disease specific proteins including LL37, S100A8 and S100A9 were significantly increased in psoriasis. The self-assembled nanoparticles based on methoxy-poly(ethylene glycol)-block-poly(L-histidine) and methoxy-poly(ethylene glycol)-block-poly(L-lactic acid) (HLNPs) were capable of interacting and absorbing these disease specific proteins, leading to the accumulation of HLNPs in peripheral inflammatory immune cells. Therefore, we proposed an “Antigen-scavenging” polypeptide nano-system assembled from the “sandwich” structure composed of HLNPs, siRNA-TNFα, and oligolysine conjugated methotrexate prodrug (HLNP-MNs), with the encapsulation of ROS-responsive methotrexate prodrug and siRNA-TNFα. We evaluated the biological fate of HLNP-MNs in vivo, the ROS-responsive release of methotrexate (MTX) and siRNA-TNFα in inflammatory immune cells, the suppression of immune response triggered by autoantigen LL37 and the inhibition of skin-homing T lymphocytes from the aspects of “nanoparticle-protein” interaction, cellular level and mouse models. The design of “Antigen-scavenging” polypeptide nanoparticles with loading of MTX and siRNA-TNFα, can shed light on restoring immune homeostasis in psoriasis.
Stem cell therapy as a potential treatment option for psoriasis
2022, Anais Brasileiros de Dermatologia
Citation Excerpt :
The immune system is rebuilt with potentially non-reactive T-cell populations from donors who do not have psoriasis. A durable remission of psoriasis (for up to 20-years) has been reported in people who have undergone allogeneic HSCT rather than autologous HSCT.32 In a contrasting report, ""transfer"" of psoriasis was documented in a 40-year-old man with acute myeloid leukemia who received a syngeneic HSCT from his phenotypically identical twin brother with a 20-year history of severe psoriasis and psoriatic arthritis.44
Psoriasis is a chronic inflammatory dermatological disorder characterized by white scales and clearly demarcated erythematous plaques. The prevalence of psoriasis varies from country to country and can occur at any age, implying that ethnicity, environmental factors, and genetic background all play a role in its onset. According to the World Psoriasis Day Consortium, 125 million people globally and 2%–3% of the overall community have psoriasis. The introduction of biological treatments has revolutionized the treatment of moderate to severe psoriasis. These novel drugs, particularly those targeting interleukin (IL)-17 and IL-23p19, can help most patients with psoriasis achieve clear or virtually clear skin with satisfactory durability. Nevertheless, none of these modern treatments are not entirely remedial in their current form, and alarmingly, a limited but growing proportion of patients with severe psoriasis are not responding satisfactorily to currently available treatments. Stem cell therapy, including regulatory T-cells, hematopoietic stem cell transplantation, and mesenchymal stromal cells, has been used in patients with recalcitrant psoriasis. This review discusses the stem cell treatments available for psoriasis.
New advanced therapy medicinal products in treatment of autoimmune diseases
2022, Translational Autoimmunity: Treatment of Autoimmune Diseases
Autoimmune diseases are the third common group of diseases in the industrialized world after cardiovascular diseases and cancers and their care are challenging with routine medical treatments. Meanwhile, advanced therapy medicinal products (ATMPs) have been very attractive in recent years, as a new candidate for the treatment of autoimmune diseases. Along with the scope of this book, this chapter is devoted to the description of different ATMPs, which have been used for the treatment of autoimmune diseases. Although a lot of different experiments have been done on animal models of autoimmune diseases, some of them could reach the clinical phases. Here, we describe the ATMPs which have been used in different clinical settings for the treatment of autoimmune diseases such as type I diabetes, rheumatoid arteritis, multiple sclerosis, vitiligo, scleroderma, pemphigus, psoriasis, celiac disease, inflammatory bowel diseases, systemic lupus erythematosus, and autoimmune vasculitis.
Evaluation of patients diagnosed with psoriasis and multiple myeloma after autologous stem cell transplantation
2021, Transfusion and Apheresis Science
Citation Excerpt :
Persistence of autoreactive T cells despite high-dose chemotherapy, reinfusion of autoreactive cells among hematopoietic stem cells, preservation of the genetic background, and re-exposure to an environmental or endogenous trigger are accused for the recurrence of psoriasis after autologous transplant [19]. In addition, it is recommended to favor allogeneic transplantation along with low-intensity or myeloablative preparative regimen to prevent recurrence of autoimmune diseases such as psoriasis, because immunological rearrangement by autologous transplantation may remain inadequate, in comparison to allogeneic transplantation [20]. Kaffenberger et al. examined 13 cases in their review evaluating psoriasis cases in the literature that were followed up after allogeneic transplantation.
The secretion of monoclonal immunoglobulins increase in chronic inflammatory disorders such as chronic infections and autoimmune diseases. This risk is further increased by the biological agents used in the treatment of autoimmune diseases such as psoriasis. Hematological malignancies occurring in patients with psoriasis provides an opportunity to evaluate the effect of autologous or allogeneic stem cell transplantation in this immune-mediated disease.
Four patients diagnosed with psoriasis are presented, having undergone autologous bone marrow transplantation (ABMT), and eventually having remission of their psoriasis, after developing multiple myeloma during follow up. Psoriasis history of the patients was 20, 23, 2 and 2 years, respectively. All of them received peroral methotrexate or topical corticosteroid therapy. Time until myeloma diagnosis were 220, 144, 25, 18 months and follow-up after ABMT were 26, 19, 15, 22 months, respectively
Psoriasis can be effectively treated with stem cell transplantation that is used in the treatment of malignancies. For this reason, stem cell transplantation can be considered as a treatment option in these patients, considering the benefit-to-harm ratio. However, uncertainty continues regarding the autologous or allogeneic application of stem cell transplantation
Efficacy of Allogeneic Hematopoietic Cell Transplantation for Autoimmune Diseases: I. Shifa et al
2021, Transplantation and Cellular Therapy
Citation Excerpt :
Indolent disease (treated with a maximum of 1 line of systemic therapy before HCT), myeloablative conditioning, GVHD, and complete chimerism were not prerequisites for remission. Among 16 psoriasis patients with conclusive remission status posttransplant (UPN 338, 442, and 1600, and ref [23,28–39]), psoriasis relapsed in 3 patients at a median of one year posttransplant and did not relapse in 13 patients. Among 9 patients without relapse in whom the duration of remission since IST discontinuation was known, the median duration was 2 years (Table 1 and Supplementary Table S6).
Allogeneic hematopoietic cell transplantation (HCT) may be efficacious for autoimmune diseases (AIDs), but its efficacy for individual AIDs is unknown. Factors influencing the likelihood of relapse for each AID are also unknown. This study aimed to determine the likelihood of relapse for each common AID and to generate hypotheses about factors influencing the likelihood of relapse. We reviewed charts of adult patients with nonhematologic AIDs who had undergone HCT in Alberta (n = 21) and patients described in the literature (n = 67). We used stringent inclusion criteria to minimize the inclusion of patients whose AID may have been cured before transplantation. We also used stringent definitions of AID relapse and remission. AID relapsed in 2 of 9 patients (22%) with lupus, in 4 of 12 (33%) with rheumatoid arthritis (RA), in 0 of 4 (0%) with systemic sclerosis (SSc), in 3 of 16 (19%) with psoriasis, in 1 of 12 (8%) with Behçet's disease (BD), in 1 of 15 (7%) with Crohn's disease (CD), in 0 of 5 (0%) with ulcerative colitis (UC), in 4 of 8 (50%) with multiple sclerosis (MS), and in 3 of 3 (100%) with type 1 diabetes mellitus (T1DM). Among highly informative patients (followed for >1 year after discontinuation of immunosuppressive therapy if no relapse, or donor AID status known if relapse), relapse occurred in 0 of 3 patients with lupus, in 2 of 7 with RA, in 0 of 2 with SSc, in 3 of 6 with psoriasis, in 0 of 3 with BD, in 0 of 10 with CD, in 0 of 3 with UC, in 2 of 3 with MS, and in 2 of 2 with T1DM. There appeared to be no associations between AID relapse and low intensity of pretransplantation chemoradiotherapy, multiple lines of AID therapy (surrogate for AID refractoriness) except perhaps for lupus, absence of serotherapy for graft-versus-host disease (GVHD) prophylaxis, lack of GVHD except perhaps for lupus, or incomplete donor chimerism. Even though remission commonly occurs after HCT in lupus, RA, SSc, psoriasis, BD, CD, and UC, HCT is efficacious for only a subset of patients. The efficacy appears to be unrelated to pretransplantation therapy, GVHD, or chimerism. Large studies are needed to determine the characteristics of patients likely to benefit from HCT for each AID.
Graft-versus-host disease-associated angiomatosis: A clinicopathologically distinct entity
2014, Journal of the American Academy of Dermatology
Chronic graft-versus-host disease (GVHD) may present with various cutaneous manifestations. Isolated case reports describe eruptive angiomas in this setting.
We sought to provide a clinical and pathologic description of vascular proliferations in patients with GVHD.
Cases of documented GVHD associated with vascular proliferations were collected from the National Institutes of Health, Ohio State University, and MD Anderson Cancer Center.
Eleven patients with a diagnosis of GVHD who developed vascular proliferations were identified. All patients manifested sclerotic type chronic GVHD of the skin. Vascular lesions were first documented a median of 44 months after transplantation and occurred primarily on the lower extremities or trunk. Histopathology revealed anastomosing networks of thin-walled vascular proliferations in a vague lobular growth pattern, with overlying epidermal acanthosis, peripheral collarette, ulceration, and disorganized fibroblast-rich and fibrotic stroma. Improvement was noted in 1 patient treated with propranolol and sirolimus and 1 patient with electrocautery.
Given the retrospective nature of the study, the overall incidence of vascular lesions in patients with GVHD is unknown. Histopathology was present for review on only 3 of 11 patients.
The phenomenon of vascular lesions appears to be relatively specific for sclerotic type chronic GVHD when compared with other fibrosing diseases. We propose the term “graft-versus-host disease–associated angiomatosis” to describe this entity.

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: Conflicts of interest: None declared.

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ReviewRemission of psoriasis after allogeneic, but not autologous, hematopoietic stem-cell transplantation

Section snippets

Cases of psoriasis resolution

Discussion

Exp Hematol

Clin Haematol

Blood

Clearance of severe psoriasis after allogenic bone marrow transplantation

BMJ

Resolution of immune-mediated diseases following allogeneic bone marrow transplantation for leukemia

Bone Marrow Transplant

Psoriasis and bone marrow transplantation

BMJ

Resolution of psoriasis vulgaris following allogeneic bone marrow transplantation for aplastic anemia

Rinsho Ketsueki

Transfer of autoimmune thyroiditis and resolution of palmoplantar pustular psoriasis following allogeneic bone marrow transplantation

Bone Marrow Transplant

Long-term outcome of autoimmune disease following allogeneic bone marrow transplantation

Arthritis Rheum

Resolution of psoriasis after allogeneic bone marrow transplantation for chronic myelogenous leukemia: late complications of therapy

Bone Marrow Transplant

Will mixed chimerism cure autoimmune diseases after a nonmyeloablative stem cell transplant?

Transplant

Resolution of psoriasis following allogeneic bone marrow transplantation for chronic myelogenous leukemia: case report and review of the literature

Am J Hematol

Induction of graft-versus-autoimmune (GVA) disease effect against refractory psoriasis by complete donor-type chimerism and graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplant

Amelioration of severe psoriasis with psoriatic arthritis for 20 years after allogeneic hematopoietic stem cell transplantation

Ann Rheum Dis

Review
Remission of psoriasis after allogeneic, but not autologous, hematopoietic stem-cell transplantation