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Stem Cell Therapy in Neuroimmunological Diseases and Its Potential Neuroimmunological Complications. Cells 2022; 11:cells11142165. [PMID: 35883607 PMCID: PMC9318423 DOI: 10.3390/cells11142165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Since the 1990s, transplantations of hematopoietic and mesenchymal stem cells (HSCT and MSCT) and dendritic cell (DCT) have been investigated for the treatment of neurological autoimmune disorders (NADs). With the growing number of transplanted patients, awareness of neuroimmunolgical complications has increased. Therefore, an overview of SCT for the most common NADs and reports of secondary immunity after SCT is provided. Methods: For this narrative review, a literature search of the PubMed database was performed. A total of 86 articles reporting on different SCTs in NADs and 61 articles dealing with immune-mediated neurological complications after SCT were included. For multiple sclerosis (MS), only registered trials and phase I/II or II studies were considered, whereas all available articles on other disorders were included. The different transplantation procedures and efficacy and safety data are presented. Results: In MS patients, beneficial effects of HSCT, MSCT, and DCT with a decrease in disability and stabilization of disease activity have been reported. These effects were also shown in other NADs mainly in case reports. In seven of 132 reported patients with immune-mediated neurological complications, the outcome was fatal. Conclusions: Phase III trials are ongoing for MS, but the role of SCT in other NADs is currently limited to refractory patients due to occasional serious complications.
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Muñoz AM, Conca ADG, Luzzi AA, Sosa PS, Sberna F, Comacchio FB, Schutz NP, Bendek GE. Multiple mononeuritis as a manifestation of graft versus host disease. Hematol Transfus Cell Ther 2022:S2531-1379(22)00046-3. [PMID: 35624017 DOI: 10.1016/j.htct.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022] Open
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Abstract
Recent decades have demonstrated significant strides in cancer screening, diagnostics and therapeutics. As such there have been dramatic changes in survival following a diagnosis of cancer.
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Affiliation(s)
- Matthew R D Brown
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | | | - David J Magee
- The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
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Zhao Y, Chen X, Zhang W, Fang X, Liu X, Dong W. Steroid-responsive chronic inflammatory demyelinating polyradiculoneuropathy post-hematopoietic stem cell transplantation: a case report and literature review. Neurol Sci 2021; 42:4793-4799. [PMID: 34331155 DOI: 10.1007/s10072-021-05500-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yunxia Zhao
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiuying Chen
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wen Zhang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaosheng Fang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xiaohui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Tard C, Cassim F, Maurage CA, Provot F, Coiteux V. Graft-versus-host disease-related neuropathy: AMAN phenotype with improvement after plasmapheresis. Acta Neurol Belg 2020; 120:719-722. [PMID: 31552556 DOI: 10.1007/s13760-019-01211-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Céline Tard
- Univ Lille, CHU Lille, INSERM U1171, Lille, France.
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France.
- Department of Neurology, Salengro Hospital, University Lille Hospital, Emile Laine Street, 59037, Lille Cedex, France.
| | - François Cassim
- Centre de référence des maladies neuromusculaires Nord Est Ile de France, Lille, France
- Service de Neurophysiologie Clinique, CHU de Lille, Lille, France
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Xing L, Wen S, Niu Z, Wang F, Zhang X. Rituximab for acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation: a case report. Postgrad Med 2020; 132:485-488. [PMID: 32148146 DOI: 10.1080/00325481.2020.1736884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation (HSCT) is rare, and the exact pathogenesis remains unclear. Here, we report the case of a 20-year-old patient with B-cell acute lymphocyte leukemia (B-ALL) who developed acute demyelinating myelopathy approximately 10 months after HSCT. Magnetic resonance imaging revealed high T2 signal intensity lesions from the C2-T4 levels of the spinal cord. Treatments with high doses of corticosteroids, immunoglobulins, and rituximab improved his neurologic symptoms, and he achieved 44 months of leukemia-free and graft-versus-host disease (GVHD)-free survival, with no recurrence of the demyelination myelopathy. An understanding of the contribution of immune reconstitution to the pathogenesis of demyelinating myelopathy after HSCT and the association of this disease with GVHD will require more clinical cases.
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Affiliation(s)
- Lina Xing
- Department of Hematology, Hebei Key Laboratory of Hematology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Shupeng Wen
- Department of Hematology, Hebei Key Laboratory of Hematology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Zhiyun Niu
- Department of Hematology, Hebei Key Laboratory of Hematology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Fuxu Wang
- Department of Hematology, Hebei Key Laboratory of Hematology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
| | - Xuejun Zhang
- Department of Hematology, Hebei Key Laboratory of Hematology, The Second Hospital of Hebei Medical University , Shijiazhuang, China
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Barp A, Gilardin L, Afanasiev V, Delorme C, Viala K, Bernard S, Brice P, Psimaras D, Lenglet T. Subacute inflammatory demyelinating polyradiculoneuropathy complicating relapsing Hodgkin lymphoma: another immune-related adverse event of the anti-PD1 therapy? Leuk Lymphoma 2018; 60:547-549. [DOI: 10.1080/10428194.2018.1485912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Andrea Barp
- Département de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Laurent Gilardin
- Service d’Onco-Hématologie, Hôpital Saint-Louis, APHP, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche en Santé (UMR S) 1138, Centre de Recherche des Cordeliers, Equipe Immunopathology and Therapeutic Immunointervention, Paris, France
| | - Vadim Afanasiev
- Centre d’Evaluation et Traitement des Neuropathies, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Cécile Delorme
- Département de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
- Centre d’Evaluation et Traitement des Neuropathies, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Karine Viala
- Département de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
- Centre d’Evaluation et Traitement des Neuropathies, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
| | - Sophie Bernard
- Service d’Onco-Hématologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Pauline Brice
- Service d’Onco-Hématologie, Hôpital Saint-Louis, APHP, Paris, France
| | - Dimitri Psimaras
- OncoNeuroTox group: Center for investigations of patients with neurological complications after cancer treatment, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Val-de-Grâce, Paris, France
| | - Timothée Lenglet
- Département de Neurophysiologie, Hôpital de la Pitié-Salpêtrière, APHP, Paris, France
- OncoNeuroTox group: Center for investigations of patients with neurological complications after cancer treatment, Hôpitaux universitaires Pitié-Salpêtrière-Charles Foix et Val-de-Grâce, Paris, France
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Broomall E, Taylor JM, Peariso K. A 2-Year-Old Boy With Difficulty Waking After Bone Marrow Transplantation. Semin Pediatr Neurol 2018; 26:120-123. [PMID: 29961501 DOI: 10.1016/j.spen.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report a 2-year-old boy who was evaluated for difficult waking during prolonged intensive care unit admission associated with bone marrow transplant for Wiskott-Aldrich syndrome. Neurologic examination was found to be abnormal, with nuchal rigidity initially, then decreased extremity movement and areflexia developing over several days. Electromyogram showed length-dependent, axonal, sensorimotor polyneuropathy. Cerebrospinal fluid showed albuminocytologic dissociation suggestive of Guillain-Barre syndrome or acute motor and sensory axonal neuropathy variant. The patient was treated with immunotherapy and slowly showed signs of motor recovery over several months. A review of Wiskott-Aldrich syndrome, Guillain-Barre syndrome, immune-mediated complications of bone marrow transplantation, and acute weakness in the intensive care unit is provided in this case report.
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Affiliation(s)
- Eileen Broomall
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - John Michael Taylor
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Katrina Peariso
- From the Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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IgG synthesis rate and anti-myelin oligodendrocyte glycoprotein antibody in CSF may be associated with the onset of CNS demyelination after haplo-HSCT. Ann Hematol 2018; 97:1399-1406. [PMID: 29568992 DOI: 10.1007/s00277-018-3299-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
Abstract
Haploidentical hematopoietic stem cell transplant (haplo-HSCT) is an upfront and effective therapy for hematology patients, but it usually has many complications, such as neurological complications. As one of the neurological complications following haplo-HSCT, immune-mediated demyelinating diseases of the central nervous system (CNS) seriously affect a patient's quality of life. However, the incidence, risk factors, and pathogenesis of CNS demyelination are not very well understood. Thirty of the 1526 patients (1.96%) suffered from CNS demyelination. In univariate analysis, we found that blood-brain barrier (BBB) permeability and the CSF IgG synthesis index (IgG-Syn) were related to the occurrence of CNS demyelination (p < 0.05). In a multivariate analysis, the IgG-Syn (OR = 1.017, 95% CI 1.003-1.031, p = 0.019) and CSF anti-myelin oligodendrocyte glycoprotein antibody (MOG.Ab) (OR = 12.059, 95% CI 1.141-127.458, p = 0.038) were independently associated with the onset of CNS demyelination. We also studied the possible pathogenesis of CNS demyelination. Immune reconstitution (the cell proportions of CD19+ B cells, CD3+ T cells, and CD4+ T cells); the counts of leucocytes, lymphocytes, monocytes, and platelets; and the levels of immunoglobulins A, G, and M 30, 60, and 90 days after HSCT showed no significant differences between CNS demyelination and no demyelination (p > 0.05). The probabilities of overall survival showed no significant differences between patients with and without demyelination (p > 0.05). Only four deaths in 30 patients, but bringing projected survival to less than 20%.We imply that IgG-Syn and CSF MOG. Ab may be associated with the onset of CNS demyelination during 2 weeks of neurological symptoms in patients with brain or spinal cord MRI abnormality. Immune reconstitution may not be the pathogenesis of CNS demyelination.
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Brown M, Farquhar-Smith P. Pain in cancer survivors; filling in the gaps. Br J Anaesth 2017; 119:723-736. [DOI: 10.1093/bja/aex202] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Simonsen CS, Hansen G, Piehl F, Edland A. Chronic inflammatory demyelinating polyradiculoneuropathy occurring after autologous haematopoietic stem cell transplantation for multiple sclerosis. Mult Scler J Exp Transl Clin 2017; 2:2055217316658304. [PMID: 28607734 PMCID: PMC5433337 DOI: 10.1177/2055217316658304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022] Open
Abstract
We describe the case of a man in his 40 s with aggressive multiple sclerosis (MS) who received autologous haematopoietic stem cell transplantation (AHSCT) and subsequently developed probable, if not definite, Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and haematological complications. Autoimmune conditions occurring as a side effect of allogenic transplantations are well known in the context of haematological malignancies, but only rarely reported for autologous transplantations. Our case demonstrates that although AHSCT may be effective for suppressing MS inflammatory activity, the profound changes to the immune repertoire may lead to other clinically relevant autoimmune phenomena. A careful benefit-risk evaluation should be conducted in all cases where AHSCT is considered.
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Affiliation(s)
| | - Gunnar Hansen
- Department of Neurology, Drammen Hospital, Vestre Viken HF, Norway
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institut, Sweden
| | - Astrid Edland
- Department of Neurology, Drammen Hospital, Vestre Viken HF, Norway
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Complete neurologic and cognitive recovery after plasmapheresis in a patient with chronic inflammatory demyelinating polyneuropathy after allogeneic hematopoietic stem cell transplantation. Wien Klin Wochenschr 2016; 128:384-6. [PMID: 26919852 PMCID: PMC4875051 DOI: 10.1007/s00508-016-0972-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/10/2016] [Indexed: 11/16/2022]
Abstract
Neurologic complications after allogeneic hematopoietic stem cell transplantation (HSCT) are rare but poorly understood. We present a case report of a 57-year-old-male patient who was diagnosed in 2009 with acute myeloid leukemia (AML). He received two standard induction chemotherapies, as well as a following consolidation. Six months later, an allogeneic HSCT was performed. Shortly after HSCT the patient developed progressive polyneuropathy of the lower legs and hypoesthesia. Five months later a severe dementia followed. All images of the brain and spine showed no specific pathologies. High dose corticosteroids and immunoglobulins did not improve the neurologic symptoms. Due to severe worsening of the neuropsychiatric status and the clinical presentation, chronic inflammatory demyelinating polyneuropathy (CIDP) was suspected. Therefore, the patient received ten cycles of plasmapheresis. The patient showed a significant improvement of the neuropsychiatric symptoms and cognitive status. CONCLUSIONS: Immune mediated neuropathies after allogeneic HSCT, such as CIDP, have great variability in symptoms and presentation and are challenging to diagnose and treat. Plasmapheresis is a safe and efficient treatment for patients with unclear persisting autoimmune neuropathy after HSCT.
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Cocito D, Romagnolo A, Rosso M, Peci E, Lopiano L, Merola A. CIDP-like neuropathies in graft versus host disease. J Peripher Nerv Syst 2015; 20:1-6. [DOI: 10.1111/jns.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Dario Cocito
- Department of Neuroscience; University of Turin; Torino Italy
| | | | - Michela Rosso
- Department of Neuroscience; University of Turin; Torino Italy
| | - Erdita Peci
- Department of Neuroscience; University of Turin; Torino Italy
| | | | - Aristide Merola
- Department of Neuroscience; University of Turin; Torino Italy
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Shibata M, Kato T, Awaya T, Adachi S, Heike T. Chronic immune-mediated axonal polyneuropathy following umbilical cord blood transplant for childhood-onset cerebral adrenoleukodystrophy. Pediatr Transplant 2012; 16:E388-91. [PMID: 22715901 DOI: 10.1111/j.1399-3046.2012.01748.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Peripheral polyneuropathy is an unusual complication after organ transplantation and HSCT. The present study describes the case of an eight-yr-old boy diagnosed with ALD who underwent HLA-matched UCBT under a reduced-intensity conditioning regimen and developed progressive walking difficulty and hand clumsiness 11 months after transplantation. These symptoms were associated with cGVHD, identified as immune-mediated axonopathy by electrophysiological examination and sural nerve biopsy. Peripheral polyneuropathy should be kept in mind as a complication of GVHD.
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Affiliation(s)
- Minoru Shibata
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Muscle cramps and neuropathies in patients with allogeneic hematopoietic stem cell transplantation and graft-versus-host disease. PLoS One 2012; 7:e44922. [PMID: 23028681 PMCID: PMC3444502 DOI: 10.1371/journal.pone.0044922] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 08/09/2012] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Graft-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. METHODS In 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. RESULTS Nine 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. CONCLUSION Muscle 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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Immune-mediated peripheral neuropathy occurring simultaneously with recurrent graft-versus-host disease after allogenic hematopoietic stem cell transplantation. Leuk Res 2012; 36:e63-5. [DOI: 10.1016/j.leukres.2011.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 11/19/2022]
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Grauer O, Wolff D, Bertz H, Greinix H, Kühl JS, Lawitschka A, Lee SJ, Pavletic SZ, Holler E, Kleiter I. Neurological manifestations of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: report from the Consensus Conference on Clinical Practice in chronic graft-versus-host disease. Brain 2010; 133:2852-65. [PMID: 20846944 DOI: 10.1093/brain/awq245] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A major obstacle of allogeneic haematopoietic stem cell transplantation is graft-versus-host disease, an immune-mediated disorder that affects multiple tissues and organs with varying severity. Neurological complications of acute and chronic graft-versus-host disease are rare but can produce severe clinical problems with significant morbidity and mortality. In this article, we review neurological manifestations of chronic graft-versus-host disease that comprise immune-mediated neuropathies, myasthenia gravis and myositis in the peripheral nervous system and various cerebrovascular complications, demyelination and immune-mediated encephalitis in the central nervous system. The National Institutes of Health consensus on criteria for clinical trials in chronic graft-versus-host disease recommended that the diagnosis of chronic graft-versus-host disease of the nervous system can be made only when other organs are affected by graft-versus-host disease and frequent neurological differential diagnoses such as drug-induced toxicities or opportunistic infections are excluded. The Consensus Conference on Clinical Practice in chronic graft-versus-host disease, held in autumn 2009 in Regensburg, aimed to summarize the literature and to provide guidelines for the diagnostic approach in children and adults with neurological manifestations of chronic graft-versus-host disease. Moreover, we present therapeutic recommendations and their level of evidence for the management of these complications. Overlapping symptoms and comorbidities after allogeneic haematopoietic stem cell transplantation and the limited knowledge about the underlying biological mechanisms of chronic graft-versus-host disease affecting the nervous system emphasize the need for further experimental and clinical investigations.
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Affiliation(s)
- Oliver Grauer
- Department of Neurology, University Medical Centre Regensburg, Universitätsstraße 84, Regensburg, Germany
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Mahdi-Rogers M, Kazmi M, Ferner R, Hughes RAC, Renaud S, Steck AJ, Fuhr P, Halter J, Gratwohl A, Tyndall A. Autologous peripheral blood stem cell transplantation for chronic acquired demyelinating neuropathy. J Peripher Nerv Syst 2009; 14:118-24. [PMID: 19691534 DOI: 10.1111/j.1529-8027.2009.00221.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Six patients with chronic acquired demyelinating neuropathy (CADP) were treated with autologous peripheral blood stem cell transplantation (PBSCT). Two with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome improved-improvement was sustained in one but relapsed and required repeat transplant in the other. Two of the three with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and one with an IgM paraprotein and antibodies to nerve improved--of the responders, one relapsed after 18 months and the other was in remission after 6 months. Four developed neutropenic septicemia and pneumonia. The role of PBSCT in CADP refractory to other treatment deserves further investigation but the serious adverse events and lack of sustained response in some patients emphasize the need for caution.
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Teive HAG, Funke V, Bitencourt MA, de Oliveira MM, Bonfim C, Zanis-Neto J, Medeiros CRD, Zétola VF, Werneck LC, Pasquini R. Neurological complications of hematopoietic stem cell transplantation (HSCT): a retrospective study in a HSCT center in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:685-90. [PMID: 18949262 DOI: 10.1590/s0004-282x2008000500014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 07/23/2008] [Indexed: 11/22/2022]
Abstract
We present the neurological complications evaluated in a series of 1000 patients who underwent hematopoietic stem cell transplantation (HSCT). Central nervous system (CNS) neurological complications, particularly brain hemorrhages, were the most common, followed by seizures and CNS infections. An unusual neurological complication was Wernicke's encephalopathy. Less frequent neurological complications were metabolic encephalopathy, neuroleptic malignant syndrome, reversible posterior leukoencephalopathy syndrome, brain infarct and movement disorders. The most common neurological complication of the peripheral nervous system was herpes zoster radiculopathy, while peripheral neuropathies, inflammatory myopathy and myotonia were very rarely found.
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Affiliation(s)
- Hélio A G Teive
- Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil.
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Kuitwaard K, van Doorn PA. Newer Therapeutic Options for Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Drugs 2009; 69:987-1001. [DOI: 10.2165/00003495-200969080-00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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