Acquired hemophilia A (AHA) is a bleeding disorder characterized by the immunological inhibition of factor VIII (FVIII) of the hemostatic pathway leading to hemorrhagic events. Different domains of FVIII are the target of autoantibodies (mainly immunoglobulin (Ig) G) leading to the deficiency of FVIII. Several factors have been associated with the activation of the auto-immunity towards FVIII. Emerging evidence implicates CD4+ T cell activation in mediating this autoimmune response, with their involvement like that observed in congenital hemophilia A. Several genes such as HLA II DRB*16, DQB1*0502, and CTLA-4 + 49 are responsible for the pathogenesis of AHA. Epigenetic modifications and mainly long-coding RNAS (lncRNAs) are potentially contributing to the pathogenesis of AHA. The treatment approach of AHA includes the management of acute bleeding events and the administration of immunosuppressive medications. This review aimed to summarize the published data on the genetics and epigenetics of AHA. The severity and the mortality of this disease are creating an emerging need for further research in the field of the genetics and epigenetics of acquired hemorrhagic disorder.

Autologous hematopoietic cell transplantation (HCT) has been introduced for patients with severe systemic sclerosis (SSc). We aimed to assess the safety and long-term efficacy of HCT modality for severe SSc, refractory to conventional therapy, in 17 patients who were referred to our – The Joint Accreditation Committee of the International Society for Cellular Therapy (ISCT) and the European Group for Blood and Marrow Transplantation (EBMT)-accredited Unit from 2005 to 2024. Peripheral blood stem cells were collected using cyclophosphamide and GCSF. An immunoablative conditioning regimen of cyclophosphamide and anti-thymocyte globulin was administered. Disease assessments were done before and after mobilization treatment and post-transplant, focusing on skin sclerosis, pulmonary function, cardiac involvement, gastrointestinal manifestations, the necessity for additional immunosuppressive therapy, and overall patient well-being. Before transplantation, 13/17 (76%) of the patients had diffuse skin involvement with a mean mRSS of 31 (2–49), 2/17 (12%) had pulmonary hypertension, and 14/17 (82%) had gastrointestinal manifestations. The median follow-up period was 9.1 (0. 5–14. 3) years. Improvement of skin sclerosis was observed, with a decrease in mRSS before transplantation from 31 (2–49) to 7 (2–22) post-HCT. Lung function remained stable in 8/15 (53%) patients, improved in 5/15 (33%), and deteriorated in 2/15 (13%). Gastrointestinal manifestations were improved in 12/14 (86%) patients, while all patients (16/16, 100%) reported a great impact on their quality of life. Ten out of the 16 (63%) patients were free of immunosuppressive drugs after the HCT. Overall survival was 16/17 (94.2%). Concerning TRM, there was one (1/17, 5.8%) death early post-transplant. In this specific cohort of selected patients with severe SSc refractory to immunosuppressive medications, autologous HCT led to improvements in the outcomes assessed.