Immune-mediated peripheral neuropathy occurring simultaneously with recurrent graft-versus-host disease after allogenic hematopoietic stem cell transplantation

Doi, Yukiko; Sugahara, Hiroyuki; Yamamoto, Kazutaka; Ujiie, Hidetoshi; Kakimoto, Tsunayuki; Sakoda, Hiroto

doi:10.1016/j.leukres.2011.11.025

Cited by 12 publications

(17 citation statements)

References 7 publications

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“…Nerve biopsy is less often required [9]. It is an important complication, and 0.6% to 4% patients develop peripheral neuropathy after an allogeneic stem cell transplant [10,11]. The pathogenesis of CIDP associated with GVHD may include the development of nerve demyelination and inflammation secondary to immune-mediated effects.…”

Section: Discussionmentioning

confidence: 99%

Leukoderma and chronic inflammatory demyelinating polyradiculoneuropathy in an adolescent with graft-versus-host disease

Okan¹,

Erbey²,

Durmus³

et al. 2015

MMJ

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A 15-year-old Iraqi male patient with acute lymphoblastic leukemia received an allogeneic bone marrow transplant from his brother. On the 18th day after the transplant, the patient developed grade II acute graft-versus-host disease, and treatment included methylprednisolone. On day 140, the patient was diagnosed with leukoderma. On day 150, the patient was admitted to hospital because of numbness and muscle weakness in the extremities and a disturbance of the gait. Neurologic examination showed muscle weakness in the upper and lower extremities and there were no deep tendon reflexes. Nerve conduction studies showed reduced conduction speeds of the motor nerves with demyelinating features. The patient was diagnosed as having a chronic inflammatory demyelinating polyradiculoneuropathy (CIDB) based on clinical and electrophysiological findings. Treatment included methylprednisolone and intravenous immunoglobulin. The neurologic function improved but the skin lesions persisted. This case shows that graft-versus-host disease can act as a triggering factor for the appearance of autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

Leukoderma and chronic inflammatory demyelinating polyradiculoneuropathy in an adolescent with graft-versus-host disease

Okan¹,

Erbey²,

Durmus³

et al. 2015

MMJ

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“…Preceding viral infection and an immunologic reaction to the virus may have been a trigger for both reactivation of GVHD and an immune‐mediated neuropathy. Management with immunosuppressive agents and IVIg suggest both cellular and humoral immunity play a role in immune‐mediated neuropathy associated with allogeneic HSCT . Another patient developed axonal GBS in the setting of cytomegalovirus (CMV) colitis 58 days after developing GVHD and being treated successfully for the colitis.…”

Section: Guillain‐barré Syndrome and Peripheral Neuropathymentioning

confidence: 99%

“…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%

“…Management with immunosuppressive agents and IVIg suggest both cellular and humoral immunity play a role in immune-mediated neuropathy associated with allogeneic HSCT. 28 Another patient developed axonal GBS in the setting of cytomegalovirus (CMV) colitis 58 days after developing GVHD and being treated successfully for the colitis. Sural nerve biopsy revealed axonal degeneration with infiltration of CD81 T-cells and macrophages.…”

Section: Guillain-barr E Syndrome and Peripheral Neuropathymentioning

confidence: 99%

“…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. 25,28,31 In 1 patient, it was thought to be a result of discontinuation of immunosuppression, and GBS was the presenting manifestation of cGVHD. In that patient, treatment with steroids, IVIg, plasmapheresis, and cyclosporine was necessary.…”

Section: Treatmentmentioning

confidence: 99%

See 2 more Smart Citations

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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Immune-mediated peripheral neuropathy occurring simultaneously with recurrent graft-versus-host disease after allogenic hematopoietic stem cell transplantation

Cited by 12 publications

References 7 publications

Leukoderma and chronic inflammatory demyelinating polyradiculoneuropathy in an adolescent with graft-versus-host disease

Leukoderma and chronic inflammatory demyelinating polyradiculoneuropathy in an adolescent with 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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