Central nervous system graft-versus-host disease (CNS-GvHD) after allogeneic haematopoietic stem cell transplantation

Abstract

A 60-year-old man presented with impaired consciousness and psychomotor agitation after a second allogeneic haematopoietic stem cell transplantation (HSCT) from a matched unrelated donor for acute myeloid leukaemia. Clinical, biological and radiological evidence suggested a diagnosis of central nervous system graft-versus-host disease (CNS-GvHD). After intrathecal infusion of methylprednisolone, the clinical symptoms as well as the radiological abnormalities disappeared. The present report illustrates the difficulties in the diagnosis and the management of CNS-GvHD, a very rare and still challenging neurological complication that can occur after allogeneic HSCT.

A Case Report of Central Nervous System Graft-Versus-Host Disease and Literature Review

“…Then we reviewed references of all selected articles to research additional articles. We selected 29 articles published between 1990 and December 2019, including 46 cases ( Table 1 ) ( 7 – 35 ), 22 with histological analysis (brain biopsy, spine biopsy, or autopsy) ( 7 , 8 , 10 , 13 , 17 – 19 , 22 , 25 , 27 , 29 , 30 , 32 – 34 ). Patients who had received an allogeneic HCT for hematological disease were selected if they had CNS abnormalities and other diagnosis (autoimmune disease, infectious diseases, hematologic malignancies relapse, or post transplantation lymphoproliferative disorders) were excluded.…”

Graft-versus-host disease of the central nervous system after liver transplantation: A rare complication

“…There have also been reports of the use of intrathecal steroids for CNS‐GVHD after allogeneic hematopoietic stem cell transplantation with mixed results . Although there are several retrospective studies and reports of different treatment modalities, there are no direct comparisons between withdrawal and intensification of immunosuppression . In the reported case, we stopped immunosuppression except for steroids.…”

“…A recent review of literature involved 34 patients (not involving LT recipients) with CNS‐GVHD who were treated with immunosuppressive therapy, including corticosteroids, intravenous immunoglobulin, plasmapheresis, cyclophosphamide, calcineurin inhibitors, mycophenolic acid, methotrexate, and etoposide, with 10 achieving complete and 15 more achieving partial responses . There have also been reports of the use of intrathecal steroids for CNS‐GVHD after allogeneic hematopoietic stem cell transplantation with mixed results . Although there are several retrospective studies and reports of different treatment modalities, there are no direct comparisons between withdrawal and intensification of immunosuppression .…”

First use of ibrutinib for the treatment of post‐transplant central nervous system graft‐versus‐host disease

“…The majority of case studies on CNS-GVHD to date have shown that the administration of corticosteroids alone can effectively and quickly improve neurological symptoms. [4][5][6] However, it remains unclear how to best manage CNS-GVHD that is refractory to front-line immunosuppressive therapies. To our knowledge, our case represents the first-ever report of using ibrutinib to treat CNS-GVHD.…”