Study Examines Risk of Alopecia Areata and Vitiligo in Stem Cell Recipients Interview with:
Rena Zuo, BA
MD Candidate at Duke University School of Medicine and

Edward W. Cowen, MD, MHSc
Senior Clinician
Head, Dermatology Consultation Service
Dermatology Branch
Center for Cancer Research National Cancer Institute
National Institutes of Health

MedicalResearch: What are the main findings of the study?

Answer: Chronic graft-vs-host disease (cGVHD) is a debilitating multisystem disease that occurs in patients receiving allogeneic hematopoietic stem cell transplantations as treatment for hematologic disorders. Although the diverse clinical presentations of cGVHD frequently mimic other autoimmune diseases such as Sjögren syndrome and systemic sclerosis, and low-titer antibodies are commonly found in patients with cGVHD, the exact pathogenesis and role of autoimmunity in cGVHD are incompletely understood.

Our study is the first to characterize and identify risk factors associated with the development of two uncommon autoimmune phenomena, specifically alopecia areata and vitiligo, in the setting of cGVHD. Laboratory markers, including 11 antibodies, transplant-related factors, and other cGVHD systemic manifestations were analyzed.

Several particularly interesting results were found:

  1. Among 282 patients with cGVHD, 15 demonstrated vitiligo (14 of 282; 4.9%) and/or alopecia areata (2 of 282; 0.7%).
  2. Female donor and female donor to male recipient sex mismatch, in particular, are significantly associated with the development of vitiligo and/or alopecia areata.
  3. Positive anti-cardiolipin (ACA) IgG was also significantly associated with development of vitiligo and/or alopecia areata.

MedicalResearch: Were any of the findings unexpected?

Answer: We were surprised to find that all 14 patients with vitiligo and/or alopecia areata who had information on donor sex received stem cells from a female donor. Nine of the 14 recipients were male, accounting for 64% cases. In addition, five patients were found to also have thyroid abnormalities.

MedicalResearch: What should clinicians and patients take away from your report?

Answer: Our study provides further evidence that stem cell donor sex represents an important transplant-related risk factor for the development of cGVHD. Specifically, our findings suggest that female donor sex is a risk factor for the development of concomitant cutaneous autoimmunity in the setting of cGVHD. Physicians should be aware of the potential for vitiligo and alopecia areata in addition to other more classic skin manifestations of cGVHD as these conditions may further impact the patient’s quality of life and psychosocial health.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Answer: Our study aimed to comprehensively evaluate risk factors associated with concomitant cutaneous autoimmunity in the setting of cGVHD, but we did not analyze specific findings associated with other organ systems. Future research should be conducted to explore transplant-related risk factors, systemic manifestations and laboratory markers for the development of concomitant autoimmune manifestations in other organ systems such as the eye, mouth, liver, and gastrointestinal tract.