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PEDIATRICS Vol. 111 No. 5 May 2003, pp. e622-e627

ELECTRONIC ARTICLE

Autoimmunity in Wiskott-Aldrich Syndrome: Risk Factors, Clinical Features, and Outcome in a Single-Center Cohort of 55 Patients

Sophie Dupuis-Girod, MD*,{ddagger}, Jacques Medioni, MD§, Elie Haddad, MD, PhD*, Pierre Quartier, MD*, Marina Cavazzana-Calvo, MD, PhD||, Françoise Le Deist, MD, PhD, Geneviève de Saint Basile, PhD#, Jean Delaunay, MD, PhD**, Klaus Schwarz, MD, PhD{ddagger}{ddagger}, Jean-Laurent Casanova, MD, PhD*,§§, Stephane Blanche, MD*,§§ and Alain Fischer, MD, PhD*,||,#

* Unité d’Immunologie et d’Hématologie pédiatriques, Hôpital Necker-Enfants Malades, Paris, France
{ddagger} Unité d’Hématologie et de Transplantation de Moelle Osseuse, Hôpital Debrousse, Lyon, France
§ Unité de Biostatistiques, Hôpital Necker-Enfants Malades, Paris, France
|| Laboratoire de Thérapie Cellulaire, Hôpital Necker-Enfants Malades, Paris, France
Laboratoire d’Immunologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
# INSERM U429, Hôpital Necker-Enfants Malades, Paris, France
** Service d’Hématologie, d’Immunologie et de Cytogénétique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
{ddagger}{ddagger} Department of Transfusion Medecin, Universitätsklinikum, Ulm, Germany
§§ Laboratoire de Génétique Humaine des Maladies Infectieuses, Université René Descartes, INSERM U550, Faculté de Médecine Necker-Enfants Malades, Paris, France

--> Objectives. To evaluate the occurrence of autoimmune and inflammatory complications in Wiskott-Aldrich syndrome (WAS) and to determine risk factors and the prognosis of such complications with the aim of improving the definition of treatment options.

Methods. We reviewed the records of 55 patients with WAS evaluated at Necker-Enfants Malades Hospital (Paris) from 1980 to 2000.

Results. Forty patients (72%) had at least 1 autoimmune or inflammatory complication. Autoimmune hemolytic anemia was detected in 20 cases (36%); in all cases, onset occurred before the age of 5 years. Other complications included neutropenia (25%), arthritis (29%), skin vasculitis (22%), cerebral vasculitis (7%), inflammatory bowel disease (9%), and renal disease (3%). The median survival of the entire population was 14.5 years. Two autoimmune complications and 1 biological factor were predictive of a poor prognosis in this population: autoimmune hemolytic anemia, severe thrombocytopenia recurring after splenectomy, and high serum immunoglobulin M (IgM) levels before splenectomy. Autoimmune hemolytic anemia was significantly more observed in patients with high serum IgM level.

Conclusions. High serum IgM concentration before splenectomy was identified as a risk factor for autoimmune hemolytic anemia; however, it must be confirmed. Autoimmune hemolytic anemia and severe thrombocytopenia recurring after splenectomy were 2 indicators of a poor prognosis. Those results suggest that patients with WAS and IgM levels more than mean + 2 standard deviations before splenectomy should be placed under strict surveillance. Furthermore, severe autoimmune complications should lead, as early as possible, to hematopoietic stem cell transplantation using the best available donor.

Key Words: arthritis • autoimmunity • autoimmune hemolytic anemia • children • hematopoietic stem cell transplantation • immunodeficiency • thrombocytopenia • vasculitis • Wiskott-Aldrich syndrome

Abbreviations: WAS, Wiskott-Aldrich syndrome • IVIG, intravenous immunoglobulin • IG, immunoglobulin • SD, standard deviation • HSCT, hematopoietic stem cell transplantation • AIHA, autoimmune hemolytic anemia • GVHD, graft-versus-host disease

Received for publication Jul 9, 2002; Accepted Dec 30, 2002.




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