Autoantibody Formation after Bone Marrow Transplantation

Cm, Smith; R, Norberg; Möller, Göran; Lönnqvist, B; Hammarström, Lennart

doi:10.1159/000116395

Cited by 21 publications

(4 citation statements)

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“…Approximately 20% of patients with chronic GVHD show positive anti-AChR antibody without myasthenic symptoms, indicating the existence of higher rates of subclinical MG [14]. In the present case, an elevated titer of anti-AChR antibody supported the diagnosis of MG, and its titer decreased in parallel with the improvement of myasthenic symptoms after immunotherapies.…”

Section: Discussionsupporting

confidence: 54%

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

et al. 2017

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Background: Chronic graft-versus-host disease (GVHD) appears several months following allogenic hematopoietic stem cell transplantation (HSCT) and is clinically analogous to autoimmune disorder. Polymyositis is a common neuromuscular disorder in chronic GVHD, but myasthenia gravis (MG) is extremely rare. Hence, its pathophysiology and treatment have not been elucidated. Case presentation: A 63-year-old man with a history of chronic GVHD presented with ptosis, dropped head, and dyspnea on exertion, which had worsened over the previous several months. He showed progressive decrement of compound muscle action potential in the deltoid muscle evoked by 3-Hz repetitive nerve stimulation, a positive edrophonium test, and elevated levels of serum anti-acetylcholine receptor antibodies, which suggested a diagnosis of generalized MG. No thymoma was found. Flow cytometric analysis revealed a remarkable depletion of peripheral Tregs (CD4

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Section: Discussionsupporting

confidence: 54%

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

et al. 2017

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“…A variety of circulating autoantibodies can be found from 20% to 61% of patients undergoing autologous bone marrow transplant [108–111], and a number of these patients may demonstrate autoantibody-mediated diseases such as myasthenia gravis and autoimmune cytopenias [112] and some cases of oral diseases, such as oral vesiculobullous (pemphigus and pemphigoid) [113–116]. …”

Section: Classification and Related Aspects Of The Oral Pathologiementioning

confidence: 99%

Oral Lesions and Lymphoproliferative Disorders

Castellarin

Pozzato

Tirelli

et al. 2010

Journal of Oncology

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Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.

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“…The one caveat is the capacity to 2.6 litres (75% of predicted). Repetitive nerve reported high incidence of elevated anti-AChR antibody titstimulation studies of the right ulnar median and peroneal ers in allogeneic BMT recipients without clinical features motor nerves were inconclusive, probably due to the of myasthenia gravis, 14 which would lead to a low positive initiation of therapy 48 h prior to the study. Anti-AChR predictive value in a patient with atypical symptoms and/or antibody titers determined by radioimmunoassay were elevfew signs.…”

mentioning

confidence: 99%

Myasthenia gravis in association with allogeneic bone marrow transplantation: clinical observations, therapeutic implications and review of literature

Mackey

Desai

Larratt

et al. 1997

Bone Marrow Transplant

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Summary:transplant; chronic graft-versus-host disease; thymectomy; review Myasthenia gravis (MG) is a rare complication of allogeneic bone marrow transplantation (BMT). We present the 11th case in the medical literature, a 23-Myasthenia gravis (MG) is a neuromuscular disorder year-old female 100 months post-allogeneic bone marcharacterized clinically by weakness and pathologic fatirow transplantation for acute myelogenous leukemia gability of skeletal muscle. The underlying pathophysio-(AML). After discontinuation of immunosuppression logy is that of a decrease in the number of acetylcholine for chronic graft-versus-host disease (GVHD) involving receptors (AChRs) at the neuromuscular junction, due to skin, gastrointestinal tract and lacrimal glands, the circulating autoantibodies directed at the acetylcholine patient developed severe, progressive dysphagia initially receptor (anti-AChR antibodies). Muscle weakness often attributed to esophageal candidiasis. With the developinvolves the eyelids, extraocular muscles, facial and bulbar ment of muscle weakness, ptosis, and dysphonia the musculature, but can be generalized and involve the proxidiagnosis of generalized myasthenia gravis was susmal limb muscles as well. The diagnosis is made on clinical pected, and confirmed by elevated anti-acetylcholine grounds supported by electrodiagnostic testing, elevated receptor antibody titer and a positive edrophonium titers of anti-AChR antibodies, and improvement in challenge. Prednisone and pyridostigmine produced strength with anticholinesterase therapy. Treatment is effecimprovement, and thymectomy was performed without tive in the majority of patients, and includes enhancement pathologic evidence of thymoma. Recurrent post-operof neuromuscular transmission with anticholinesterase ative respiratory distress required transient mechanical medications, thymectomy, immunosuppression (cortiventilation. Twenty-seven months after diagnosis, the costeroids, azathioprine, cyclosporine) and short-term patient requires maintenance prednisone to control immunomodulation (plasmapheresis and intravenous symptoms of myasthenia gravis. The clinical features of immune globulin). 1 Myasthenia gravis is an autoimmune all reported cases of MG post-allogeneic BMT are disease rarely diagnosed in the post-allogeneic bone marreviewed, and universal features include an association row transplantation (BMT) setting. It may be part of the with decreasing immunosuppression, the presence of spectrum of chronic graft-versus-host disease (GVHD), 2 other manifestations of chronic GVHD, anti-acetylchoand is associated with discontinuation of immunosuppresline receptor antibodies, and the absence of an associasion. 3 We report a patient with chronic GVHD who ted thymoma. HLA Cw1, Cw7 and DR2 were identified developed MG 100 months after allogeneic BMT for AML. at frequencies significantly above that expected from HLA antigen prevalance studies, and may be markers for increased risk of developing MG post-allogeneic Case report BMT. No statistically signi...

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Autoantibody Formation after Bone Marrow Transplantation

Cited by 21 publications

References 0 publications

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

Oral Lesions and Lymphoproliferative Disorders

Myasthenia gravis in association with allogeneic bone marrow transplantation: clinical observations, therapeutic implications and review of literature

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