Guillain–Barré syndrome after rituximab in a patient with idiopathic thombocytopenic purpura: a causal association?

Chemotherapy-induced peripheral neurotoxicity

“…In fact, targeted therapies are often cytostatic, whereas standard chemotherapy agents are cytotoxic and combination treatment is very frequent. Acute, mainly motor radiculo/neuropathies resembling Guillain-Barrè Syndrome, have been reported in patients treated with alemtuzumab, a monoclonal antibody that targets the CD52 antigen currently approved for relapsed/ refractory and high-risk untreated chronic lymphocytic leukemia [53], rituximab, a monoclonal antibody against CD20 antigen originally developed to treat rheumatoid arthritis and B-cell non-Hodgkin's lymphoma [54], and ipilimumab, a monoclonal antibody targeting human cytotoxic T-lymphocyte-associated antigen 4 approved for the treatment of metastatic melanoma [55]. CIPN is emerging as a clinically relevant issue also in the use of brentuximab vedotin, a CD30-specific antibody-drug conjugate with remarkable activity in relapsed or refractory Hodgkin's lymphoma and anaplastic large cell lymphoma.…”

Successful Treatment of Refractory Guillain-Barré Syndrome with Alemtuzumab in a Patient with Chronic Lymphocytic Leukemia

“…It is therefore possible that the patient's recent treatment with bendamustine and rituximab triggered the neurologic event. Rituximab may be beneficial in the treatment of refractory GBS and other autoimmune inflammatory neuropathies [23,24], but a possible causal association has also been described [9,25,26]. Interestingly, this patient presented with late-onset neutropenia (LON) about a couple of weeks prior to the development of his neurologic symptoms.…”

Erfolgreiche Behandlung eines therapierefraktären Guillain-Barré-Syndroms mit Alemtuzumab bei einem Patienten mit chronischer lymphatischer Leukämie

“…Daher ist es möglich, dass die kurz zuvor erfolgte Behandlung des Patienten mit Bendamustin und Rituximab die neurologischen Ereignisse ausgelöst hat. Rituximab kann in der Behandlung von therapierefraktärem GBS und anderen entzündlichen Autoimmunneuropathien von Nutzen sein [23,24], aber ein möglicher kausaler Zusammenhang ist ebenfalls beschrieben worden [9,25,26]. Interessanterweise stellte sich der Patient wenige Wochen vor dem Auftreten seiner neurologischen Symptome mit einer «Late-onset»-Neutropenie (LON) vor.…”