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Research paper
Immune-mediated neuropathies following stem cell transplantation
  1. Chafic Karam1,2,
  2. Michelle L Mauermann1,
  3. Patrick B Johnston3,
  4. Rajat Lahoria1,
  5. JaNean K Engelstad1,
  6. P James B Dyck1
  1. 1Peripheral Nerve Division, Department of Neurology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3Division of Hematology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr P James B Dyck, Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA; dyck.pjames{at}mayo.edu

Abstract

Objective To study the clinical, electrophysiological and pathological characteristics and outcome of immune-mediated neuropathy (IMN) following stem cell transplantation (SCT).

Methods Retrospective chart review of the Mayo Clinic Rochester SCT database between January 1997 and August 2012.

Results Of the 3305 patients who underwent SCT, 12 patients (0.36%) had IMN. The median time from SCT to IMN was 7 months. IMN typically presented as an asymmetric radiculoplexus neuropathy (7/12 patients) or acute polyradiculoneuropathy (Guillain–Barré syndrome) (4/12). Neurophysiology showed demyelinating neuropathy in four patients and axonal neuropathy in eight. Cerebrospinal fluid protein was increased in five of six patients (median 67 mg/dL). The Neuropathy Impairment Score (NIS) improved in all patients (mean NIS 43–10, p=0.016). Six patients died. One patient died from complications of IMN and one died from complications of the haematological disease. Five patients had recurrence of their malignancy within 4 months of the IMN and of these, four died.

Conclusions IMN occurs rarely in patients after SCT. Two possible mechanisms include (1) an immune reconstitution syndrome, supported by stereotypical neuropathy types (radiculoplexus and polyradiculoneuropathies), monophasic course and temporal association with SCT and (2) a paraneoplastic phenomenon, supported by frequent early malignancy recurrence following IMN.

  • NEUROPATHY
  • GUILLAIN-BARRE SYNDROME
  • NEUROONCOLOGY
  • PARANEOPLASTIC SYNDROME
  • PERIPHERAL NEUROPATHOLOGY

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