Gender mismatch linked with autoimmune disease in chronic graft-vs-host disease

1. Patients with chronic graft-vs-host disease (CGVHD) after allogeneic hematopoietic stem cell transplantation (AHSCT) were more likely to develop cutaneous autoimmune diseases when there was female donor to male recipient sex mismatch or if the patient had Anticardiolipin (ACA) IgG antibodies.                                           

2. In patients with CGVHD, there was no significant association between indication for transplant, CGVHD duration, intensity of immunosuppressive therapy, HLA mismatch, or relation between recipient/donor, and risk of development of vitiligo or alopecia areata.

Evidence Rating Level: 3 (Average)

Study Rundown: CGVHD is a common complication after AHSCT. The cutaneous manifestations of CGVHD can often mimic autoimmune processes. Furthermore, case reports have elucidated a possible relationship between those patients who develop CGVHD after AHSCT and the subsequent development of cutaneous autoimmune diseases such as vitiligo or alopecia areata. However, because this relationship is not well understood, the authors sought to better understand the risk factors and associations between cutaneous autoimmune diseases and CGVHD. The results showed increased risk of developing vitiligo and alopecia areata in those transplants that had donor to recipient sex mismatch, particularly female donor to male recipient; however the results were limited by the very small subset of patients, likely due to the rare nature of these diseases.

Click to read the study in JAMA Dermatology

Relevant Reading: Amelanocytic Anhidrotic Alopecia Areata-like Phenotype After Allogeneic Hematopoietic Cell Transplant

In-Depth [cross-sectional study]: Of 282 patients with CGVHD after AHSCT, 13 patients were found to have vitiligo, 1 had alopecia areata, and 1 had both vitiligo and alopecia areata. These 15 patients, mostly male (66.7%), of median age 38 were identified and demographics, laboratory parameters, and CGVHD characteristics were collected. 64.29% of these patients had female donor to male recipient gender mismatch (p=.003), Of note, 14 of 15 patients who developed cutaneous autoimmune disease, with known donor sex, had a female donor. While anti-nuclear auto-antibodies and rheumatoid factor were both frequently found in these patients, the only statistically significant autoantibody association that was significant on multivariate analysis was ACA-IgG (4 of 15, 26.67%, P=.03).

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