Guillain-Barré Syndrome as leading manifestation of Graft-versus-Host Disease in an allogeneic bone marrow transplanted patient

Thöne, Jan; Lamprecht, Susanne; Hohaus, Andreas; Erbguth, F.; Bickel, Andreas

doi:10.1016/j.jns.2010.01.020

Cited by 10 publications

(16 citation statements)

References 9 publications

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“…We confirm that disorders of the peripheral nervous system have a delayed onset and usually occur in the setting of chronic GVHD [7], [16], [17], [32]. Whereas all patients with peripheral nervous system complications in our study per inclusion criteria had acute or chronic GVHD, others have reported the occurrence of GBS, CIDP, brachial plexopathy, or multiple radiculopathies after allo-HSCT in the absence of preceding classical GVHD [10], [11], [33]. Albeit uncommon, it is conceivable that GVHD may manifest first in the peripheral nervous system.…”

Section: Discussionsupporting

confidence: 81%

“…The clinical and electrophysiological presentation of GVHD-associated acute and chronic neuropathies is heterogeneous and resembles features of Guillain-Barré syndrome (GBS) [10], [11], chronic inflammatory demyelinating polyneuropathy (CIDP) [12], [13], or chronic immune-mediated axonal polyneuropathy [14]. Usually, the diagnostic criteria of GBS or CIDP are not met completely [15], [16], [17].…”

Section: Introductionmentioning

confidence: 99%

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Muscle Cramps and Neuropathies in Patients with Allogeneic Hematopoietic Stem Cell Transplantation and Graft-versus-Host Disease

et al. 2012

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ObjectiveGraft-versus-host disease (GVHD) is an immune-mediated multisystemic disorder and the leading cause of morbidity after allogeneic hematopoietic stem cell transplantation. Peripheral nervous system manifestations of GVHD are rare but often disabling. Whereas immune-mediated neuropathies are an established feature of GVHD, muscle cramps are not well characterized.MethodsIn a single-centre retrospective cohort we studied 27 patients (age 23 to 69 years) with GVHD (acute n = 6, chronic n = 21) who complained of symptoms suggestive of peripheral nervous system complications. Clinical, laboratory and neurophysiological findings were evaluated by descriptive statistics and regression analysis to detect factors associated with muscle cramps. Patient’s sera were examined for anti-neuronal antibodies.ResultsNine patients had polyneuropathy, 4 had muscle cramps, and 14 had both. Median onset of polyneuropathy and muscle cramps was 6 and 9 months after allogeneic hematopoietic stem cell transplantation, respectively. Neurophysiology revealed a predominantly axonal polyneuropathy in 20 of 26 patients. In 4 of 19 patients electromyography showed signs of myopathy or myositis. Muscle cramps were more frequent during chronic than acute GVHD and affected muscles other than calves in 15 of 18 patients. They typically occurred daily, lasted 1 to 10 minutes with medium to severe pain intensity, compromised daily activity or sleep in 12, and were refractory to therapy in 4 patients. Muscle cramps were less likely with tacrolimus treatment and signs of severe polyneuropathy, but more likely with myopathic changes in electromyography and with incipient demyelinating polyneuropathy, shown by increased high frequency attenuation of the tibial nerve. Serological studies revealed antinuclear or antimitochondrial antibodies in a subset of patients. Two of 16 patients had a serum reactivity against peripheral nervous tissue.ConclusionMuscle cramps are associated with chronic GVHD, often compromise daily activity, and correlate negatively with axonal polyneuropathy and positively with myopathy and incipient demyelination.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Muscle Cramps and Neuropathies in Patients with Allogeneic Hematopoietic Stem Cell Transplantation and Graft-versus-Host Disease

et al. 2012

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“…In patients with demyelinating neuropathies, IVIg was given with variable improvement. The patients who developed GBS tended to have more systemic illness, and it is less clear if the GBS is related to cGVHD, immune reconstitution, infection, or even conditioning chemotherapy . In 1 patient, it was thought to be a result of discontinuation of immunosuppression, and GBS was the presenting manifestation of cGVHD.…”

Section: Treatmentmentioning

confidence: 99%

“…Clinical improvement only occurred after cyclosporine was given. Although improvement may have lagged behind treatment institution, the clinical response to cyclosporine may reflect differences in pathological mechanisms between cGVHD‐associated GBS and classical GBS …”

Section: Treatmentmentioning

confidence: 99%

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Neuromuscular complications of hematopoietic stem cell transplantation

Ruzhansky

Brannagan

2015

Muscle and Nerve

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Neuromuscular diseases such as polymyositis, dermatomyositis, peripheral neuropathy, and disorders of neuromuscular transmission are reported to be complications of hematopoietic stem cell transplantation (HSCT). Although cases have been reported with allogeneic HSCT in the setting of chronic graft versus host disease, they are also known to occur without evidence thereof and even occur in the setting of autologous HSCT. The 2005 National Institutes of Health Consensus Criteria classify polymyositis and dermatomyositis as "distinctive" features, and neuropathy and MG as "other" features. These neuromuscular complications present very similarly to the idiopathic autoimmune disorders and respond to similar treatment modalities.

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Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies

Deng

et al. 2021

American J Hematol

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Idiopathic inflammatory demyelinating diseases (IIDDs) of the central nervous system (CNS) are rare but serious neurological complications of haploidentical hematopoietic stem cell transplantation (haplo‐HSCT). However, the risk factors and a method to predict the prognosis of post‐transplantation CNS IIDDs are not available. This retrospective study first reviewed data from 4532 patients who received haplo‐HSCT during 2008–2019 in our center, and 184 patients (4.1%) with IIDDs after haplo‐HSCT were identified. Grades II to IV acute graft‐versus‐host disease (aGVHD) (p < 0.001) and chronic GVHD (cGVHD) (p = 0.009) were identified as risk factors for developing IIDDs after haplo‐HSCT. We then divided the 184 IIDD patients into a derivation cohort and validation cohort due to transplantation time to develop and validate a model for predicting the prognosis of IIDDs. In the multivariate analysis of the derivation cohort, four candidate predictors were entered into the final prognostic model: cytomegalovirus (CMV) infection, Epstein–Barr virus (EBV) infection, IgG synthesis (IgG‐syn) and spinal cord lesions. The prognostic model had an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.803–0.925) in the internal validation cohort and 0.871 (95% CI: 0.806–0.931) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. Decision curve analysis indicated that IIDD patients could benefit from the clinical application of the prognostic model. The identification of IIDD patients after allo‐HSCT who have a poor prognosis might allow timely treatment and improve patient survival and outcomes.

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Guillain-Barré Syndrome as leading manifestation of Graft-versus-Host Disease in an allogeneic bone marrow transplanted patient

Cited by 10 publications

References 9 publications

Muscle Cramps and Neuropathies in Patients with Allogeneic Hematopoietic Stem Cell Transplantation and Graft-versus-Host Disease

Muscle Cramps and Neuropathies in Patients with Allogeneic Hematopoietic Stem Cell Transplantation and Graft-versus-Host Disease

Neuromuscular complications of hematopoietic stem cell transplantation

Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies

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