Autoimmune diseases after allogeneic stem cell transplantation: a clinician's guide and future outlook.

Autoimmune disease (AD) may occur after allogeneic hematopoietic stem cell transplantation (HSCT). The autoimmune mechanism seems to be related to an imbalance of immune regulation effect of T-regulatory lymphocytes on autoreactive T-lymphocytes.: ADs include hematological ADs (HADs) and not hematologic ADs (NHADs) involving organs as thyroid, peripheral and central nervous system, skin, liver, connective tissue, gastro-intestinal tract, and kidney. To identify the risk factors for ADs, to report their clinical characteristic, and to discuss new approaches represent the areas covered in this review.some risk factors for HAD and NHAD are common and include non-malignant diseases, young age, cord blood as stem cell source, conditioning regimen without total body irradiation, alemtuzumab, anti-thymocyte globulin, T-cell depleted transplant, some viral infection, mixed chimerism, and chronic Graft versus Host Disease. In NHADs, the detection of autoantibodies is more frequent and the transfer of autoimmunity from donor to recipient represents the pathogenetic mechanism responsible for these complications.New therapeutic approaches as bortezomib, daratumumab, sirolimus, eculizumab, eltrombopag appear promising in terms of better efficacy and reduced toxicity compared to traditional therapies. New horizons based on personalized therapies will allow to improve the prognosis of AD.