Development of Lhermitte's sign after bone marrow transplantation

Abstract

The authors observed Lhermitte's sign in four patients after bone marrow transplantation (BMT) for hematologic malignancies. Three patients had acute myelogenous leukemia (AML), and one had chronic myelogenous leukemia. Before BMT, the patients with AML received daunorubicin, cytosine arabinoside and etoposide, whereas the patient with chronic myelogenous leukemia received hydroxyurea. One patient with AML received MY‐9 antibody‐depleted autologous BMT. The other patients received human lymphocyte antigen‐identical, allogeneic BMT. Preparative therapy for BMT was cytosine arabinoside, cyclophosphamide, and total body exposure to radiation for two patients, and busulfan, cyclophosphamide, and no exposure to radiation in two other patients. Lhermitte's sign appeared 4 to 8 months after BMT and resolved spontaneously after 2 to 5 months. Neurologic sequelae had developed in none of the patients 16 to 34 months after BMT. No unifying etiologic factor could be identified in these patients. The development of Lhermitte's sign after BMT appears to be a benign, self‐limited phenomenon that requires no specific treatment.

Oxaliplatin-Induced Lhermitte Sign. A Case Report and Review of Literature

“…Its onset might be delayed by weeks to months, with the most common chemotherapy culprit being cisplatin 8,9 and oxaliplatin. [10][11][12] Lhermitte phenomenon has been reported in regimens that have included cyclophosphamide 13 and fludarabine. 14 During our literature search, we identified 13 reported cases of oxaliplatin-associated Lhermitte sign (Table 1).…”

Lhermitte's sign as a presenting symptom of primary spinal cord tumor

“…For patients in whom LS develops as part of an ongoing illness, the symptoms usually occur in one of the following situations: cisplatin neurotoxicity during high-dose chemotherapy, radiation injury to spinal cord contained within treatment ports, and during bone marrow transplantation [7,8,[14][15][16]24]. The cisplatin-related LS is common (up to 40% of patients on high-dose chemotherapy) and usually develops in patients already affected by cisplatin peripheral neuropathy [8].…”

Lhermitte's sign: Review with special emphasis in oncology practice

“…Head and neck trauma [17,18,[26][27][28][29] Rare, individual case reports Lhermitte's sign was first described in association with this condition Herpes zoster infection [30] Rare, individual case reports Behcet's disease [31,32] Rare, individual case report Systemic lupus erythematosus [33] Rare, individual case reports Nitrous oxide abuse [34][35][36] Rare Pathophysiology similar to vitamin B12 deficiency Cavernous angioma of the spinal cord [37] Rare, individual case reports Radiotherapy related LS [6,[41][42][43]69] Common after head and neck radiation treatment Observed with radiation fields covering cervical and thoracic spinal cord segments Chemotherapy related LS [49][50][51][52][53][54][55][56][57][58][59][60][61][62] Rare Underreporting may explain rarity; mostly associated with cisplatin and oxaliplatin Bone marrow transplantation [63] Rare, individual case reports Multiple factors may be responsible Spinal cord tumors [19,21,67,68] Rare Primary or metastatic tumors reported to be between 3.6% and 13% in large patient groups receiving radiotherapy for head and neck and thoracic malignancies [6]. In one study, nasopharyngeal carcinoma patients treated primarily by radiotherapy, LS was observed in 121 out of 1171 patients (10.3%) …”