Brachial plexopathy following high-dose melphalan and autologous peripheral blood stem cell transplantation

Neuralgic amyotrophy following high-dose melphalan and autologous peripheral blood stem cell transplantation for AL amyloidosis

“…An autoimmune process has previously been postulated, especially given the known phenomenon of immune dysregulation following SCT during the period of immune reconstitution [8]. Toxicity from induction chemotherapy seems unlikely, because prior case reports of neuralgic amyotrophy following hematopoietic SCT used different chemotherapy regimens [5]. Direct trauma was not a contributing factor in either case; both patients had an internal jugular tunneled venous catheter on the right side, but their shoulder pain was worse on the left side.…”

“…These two cases of neuralgic amyotrophy following HDM/SCT are, to our knowledge, the first reported cases in association with AL amyloidosis. Previously, a handful of neuralgic amyotrophy cases with similar time courses have been described after both autologous and allogeneic SCT in association with multiple myeloma, non-Hodgkin's lymphoma, myelodysplastic syndrome, diffuse large B-cell lymphoma, and multiple sclerosis [5][6][7]. An autoimmune process has previously been postulated, especially given the known phenomenon of immune dysregulation following SCT during the period of immune reconstitution [8].…”

“…It is treated conservatively with analgesics, physical therapy, and occasionally steroids in the acute period [1]. Parrish et al [5] reported three cases of neuralgic amyotrophy in patients with multiple myeloma following high-dose melphalan and autologous stem cell transplantation (HDM/SCT), but there has never been a reported case after treatment of immunoglobulin light chain (AL) amyloidosis following HDM/SCT.…”