Contrary to previous research, some patients with atopy who undergo allogeneic hematopoietic cell transplantation (AHCT) may be cured even if the donor is atopic, according to research published in Bone Marrow Transplantation.
Investigators aimed to determine whether atopic disease could be cured or transferred from donor to recipient, as there is evidence, though unconfirmed, that AHCT can either transfer atopy from donor to recipient when the donor has the condition and the recipient does not (D+R-), or cure atopy in a recipient with the condition when the donor does not have it (D-R+).
Of the 54 participants including in the study, the median age at transplant was 46 years (range, 4-64 years), one-third of patients had acute myeloid leukemia, and 50% had a human leukocyte antigen–matched sibling. The median donor age at transplant was 34 years (range, 7-60 years).
Among all AHCT procedures included in this study, 18 (33%) had an atopic donor and recipient (D+R+), 13 (24%) had a nonatopic donor and recipient (D-R-), 11 (20.4%) had an atopic donor and nonatopic recipient, and 12 (22.2%) had a nonatopic donor and an atopic recipient.
At a follow-up of at least 2-years post-HCT, 7 of 12 (58%) D-R+ patients became nonatopic, while only 1 of 11 (9%) D+R- patients became atopic. While 11 of 13 (85%) D-R- patients remained nonatopic, 11 of 18 (61%) D+R+ patients became nonatopic, as well.
“In conclusion, ‘cure’ of atopy with HCT occurs in about half patients, albeit probably not due to the replacement of atopic with nonatopic immune system but possibly due to an immune reset analogous to that observed in some autoimmune disease patients after autologous HCT,” the authors concluded. They added that prospective trials are needed to confirm these findings.
Whiteside S, Chin A, Tripathi G, et al. Curtability and transferability of atopy with allogeneic hematopoietic cell transplantation [published online March 30, 2020]. Bone Marrow Transplant. doi: 10.1038/s41409-020-0876-7