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Howell NA, Arya S, Tai PC, Sadeghian H, Sakhdari A, Wu R, Prica A. Guillain-Barré syndrome as an early manifestation of angioimmunoblastic T-cell lymphoma. BMJ Case Rep 2022; 15:e246176. [PMID: 35589261 PMCID: PMC9121415 DOI: 10.1136/bcr-2021-246176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/04/2022] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare condition caused by autoimmune damage of peripheral nerves. We describe a case where a man in his 80s presented with subacute, progressive fatigue and weakness. He had received an outpatient work-up for possible haematological malignancy, but eventually presented to the emergency department for worsening weakness. A physical exam and cerebrospinal fluid analysis suggested a diagnosis of GBS. Subsequently, a pathological diagnosis of angioimmunoblastic T-cell lymphoma was made. The patient underwent intravenous immunoglobulin treatment for GBS and was started on cyclophosphamide, doxorubicin, vincristine and prednisone therapy. Prior research has suggested that incident malignancy may be associated with GBS, which may be caused by a paraneoplastic-type phenomenon, malignancy-associated immune dysregulation or an autoimmune reaction triggered by a common exposure. Clinicians should be aware of the possible association between these two conditions and should remain open minded to the possibility of non-infectious triggers for GBS.
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Affiliation(s)
| | - Sumedha Arya
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Peter C Tai
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Hamid Sadeghian
- Division of Neurology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Ali Sakhdari
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Robert Wu
- Division of General Internal Medicine, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anca Prica
- Division of Haematology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Kyriakou C, Canals C, Goldstone A, Caballero D, Metzner B, Kobbe G, Kolb HJ, Kienast J, Reimer P, Finke J, Oberg G, Hunter A, Theorin N, Sureda A, Schmitz N. High-Dose Therapy and Autologous Stem-Cell Transplantation in Angioimmunoblastic Lymphoma: Complete Remission at Transplantation Is the Major Determinant of Outcome—Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol 2008; 26:218-24. [DOI: 10.1200/jco.2008.12.6219] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposePatients with angioimmunoblastic T-cell lymphoma (AITL) have poor prognoses with current conventional chemotherapy. The aim of this study was to evaluate the effect of high-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) on patients with AITL.Patients and MethodsWe report a retrospective, multicenter study of 146 patients with AITL who received ASCT. The source of the stem cells was peripheral blood in 143 patients. The conditioning regimen varied, and 74% of the patients received carmustine and 1,3-bis(2-chloroethyl)-1-nitrosourea; etoposide; ara-C; and melphalan chemotherapy.ResultsAfter a median follow-up of 31 months (range, 3 to 174 months), 95 patients (65%) remained alive, and 51 patients (35%) died. Forty-two patients died as a result of disease progression, and nine died as a result of regimen-related toxicity. The cumulative incidence of nonrelapse mortality was 5% and 7% at 12 and 24 months, respectively. The actuarial overall survival (OS) was 67% at 24 months and 59% at 48 months. The cumulative incidence of relapse was estimated at 40% and 51% at 24 and 48 months, respectively. Disease status at transplantation was the major factor that impacted outcome. Patients who received a transplant during first complete remission (CR) had significantly superior progression-free survival and OS. The estimated PFS rates for patients who received their transplants in CR were 70% and 56% at 24 and 48 months, respectively; 42% and 30% for patients with chemotherapy-sensitive disease at those time points, respectively; and 23% at both time points for patients with chemotherapy-refractory disease.ConclusionThis study shows that HDT and ASCT offers the possibility of long-term disease-free survival to patients with AITL. Early transplantation is necessary to achieve optimal results.
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Affiliation(s)
- Charalampia Kyriakou
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Carmen Canals
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Anthony Goldstone
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Dolores Caballero
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Bernd Metzner
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Guido Kobbe
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Hans-Jochem Kolb
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Joachim Kienast
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Peter Reimer
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Jurgen Finke
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Gunnar Oberg
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Ann Hunter
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Niklas Theorin
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Anna Sureda
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
| | - Norbert Schmitz
- From the University College London; European Bone Marrow Transplantation Group, London; and Leicester Royal Infirmary, Leicester, United Kingdom; Hospital Clínico Servicio de Hematología, Salamanca; and Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; University Hospital, Dept. of Hematology; and University Hospital, Department of Medicine, Uppsala, Sweden; University of Freiburg, Department of Medicine -Hematology, Oncology, Freiburg; Medical Klinik, Wurzburg; University of Münster, Department of
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Baek JY, Park SR, Choi IS, Kim SI, Kim DW, Kim JH, Yoon SS, Park S, Kim BK, Kim NK, Heo DS. Angioimmunoblastic T-cell Lymphoma: Clinical Characteristics and Treatment Outcomes. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.1.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ji Yeon Baek
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sook Ryun Park
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In Sil Choi
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Il Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seonyang Park
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Byoung Kook Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Noe Kyeong Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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