Interstitial lung disease with anti-melanoma differentiation-associated gene 5 antibody after allogeneic hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) 2022-09, Vol.57 (9), p.1382-1388
• Main Authors: Tamaki, Masaharu, Matsumi, Shimpei, Nakasone, Hideki, Nakamura, Yuhei, Kawamura, Masakatsu, Kawamura, Shunto, Takeshita, Junko, Yoshino, Nozomu, Misaki, Yukiko, Yoshimura, Kazuki, Gomyo, Ayumi, Tanihara, Aki, Okada, Yosuke, Kusuda, Machiko, Kameda, Kazuaki, Kimura, Shun-ichi, Kako, Shinichi, Kanda, Yoshinobu
• Format: Article
• Language: English
• Subjects: 631/250; 692/699/249; Antibodies; Bone marrow; Calcineurin; Calcineurin inhibitors; Cell Biology; Cell differentiation; Complications; Cryopreservation; Cyclophosphamide; Dermatomyositis; Differentiation; Graft-versus-host reaction; Hematology; Hematopoietic stem cells; Immunosuppressive agents; Inflammation; Internal Medicine; Lung diseases; Medicine; Medicine & Public Health; Melanoma; Prednisolone; Public Health; Respiratory failure; Stem cell transplantation; Stem Cells; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-022-01730-6

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody is one of auto-immune antibodies which is associated with a rare subtype of dermatomyositis (DM), and MDA5-DM is well-characterized by rapid progressive interstitial lung disease (ILD) which in part resembles pulmonary complications after allogeneic hematopoietic cell transplantation (allo-HCT). However, previous studies about anti-MDA5 antibody after allo-HCT were extremely limited. Here, we present 4 cases of ILD with anti-MDA5 antibody after allo-HCT. All of the cases showed rapidly progressive clinical course and 3 of 4 cases died despite intensive immunosuppressive therapies which included prednisolone, cyclophosphamide and calcineurin inhibitor. Additionally, 3 of 4 cases had tested positive for anti-MDA5 antibody by using cryopreserved plasma which were collected about 2–3 months before the diagnosis of MDA5-DM-ILD. It suggests that an inflammatory condition due to MDA5-DM-ILD might have sub-clinically occurred before the development of respiratory failure. The current cases suggest that the clinical feature was relatively similar to classical MDA5-DM-ILD, although it is difficult to distinguish MDA5-DM-ILD from chronic GVHD and other pulmonary complications after allo-HCT. Since clinical courses of MDA5-DM-ILD is considerably aggressive, it is important to discriminate MDA5-DM-ILD from other complications after allo-HCT.