Neurologic Complications of Hematologic Malignancies
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This document discusses the neurologic complications that can arise from hematologic malignancies. Acute leukemias, especially lymphoblastic types, have the highest risk of involving the central nervous system at diagnosis or relapse. Lymphoid neoplasms with a more diffuse appearance also commonly affect the CNS, while Hodgkin's disease rarely invades the CNS. After the chemotherapy era, CNS involvement became more frequent, rising from 4% to 40% between 1947-1960. Prophylaxis with cranial irradiation or intrathecal chemotherapy can reduce the risk of CNS involvement to around 4%.
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ORIGINAL ARTICLENeuromuscular complications after hematopo.docx
ORIGINAL ARTICLE
Neuromuscular complications after hematopoietic stem
cell transplantation
Susanne Koeppen & Abhiyrahmi Thirugnanasambanthan &
Michael Koldehoff
Received: 19 December 2013 /Accepted: 20 March 2014 /Published online: 29 March 2014
# Springer-Verlag Berlin Heidelberg 2014
Abstract
Purpose The aim of this study was to analyze the occurrence
of neuromuscular symptoms in recipients of allogeneic hema-
topoietic stem cell transplantation (HSCT) for treatment of
malignant hematopoietic disease.
Methods Among 247 outpatients after allogeneic HSCT, we
conducted a prospective non-interventional study between
July 2011 and August 2013. During follow-up visits, clinical
and electrophysiological findings were correlated to the pres-
ence of autoantibodies/alloantibodies and to frequencies of
lymphocyte subpopulations in peripheral blood.
Results Resulting in an incidence of 8.1 %, 20 patients were
diagnosed with neuromuscular complications at a median
onset of 12 months post-transplant. Five patients (25 %) were
identified with polyneuropathy (PNP), ten patients (50 %)
with combined PNP and myopathy, four patients (20 %) with
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myasthenia gravis (MG). Immune-mediated sensorimotor
PNP after HSCT is characterized by a predominantly axonal
lesion and can be overlapping with neurotoxic side effects.
The latency between HSCT and development of PM varied
between 60 days and 72 months. In general, PM occurs
parallel to graft-versus-host disease (GvHD) after tapering of
immunosuppressive medication. Typical clinical features are
proximal bilateral limb weakness with muscle atrophy. Auto-
antibodies (Ab) were detected in 12 patients, myositis-specific
Ab only in one patient. In patients with progressive
neurological symptoms, a decrease in the CD4/CD8 T cell
ratio was observed.
Conclusions GvHD-related myositis appeared similar to idi-
opathic myositis regarding clinical and electromyographical
findings. As outcome measure, sequential analysis of lympho-
cyte subpopulations in peripheral blood seems to be more
suitable than Ab measurements. Whereas peripheral neuropa-
thies are commonly observed shortly after HSCT, MG is a rare
complication in the late post-HSCT phase.
Keywords Allogeneic hematopoietic stem cell
transplantation . Graft-versus-host disease . Polyneuropathy .
Polymyositis . Myasthenia gravis
Abbreviations
AChR Ab Acetylcholine receptor antibody
AL Acute leukemia
ALL Acute lymphocytic leukemia
ANA Antinuclear antibodies
AML Acute myeloid leukemia
Ab Autoantibodies
CK-MB Creatine kinase-MB
CLL Chronic lymphocytic leukemia
CML Chronic myeloid leukemia
GvHD Graft-versus-host disease
HSCT Hematopoietic stem cell transplantation
ND Not done
MCL Mantle cell lymphoma
MG Myasthenia gravis
MM Multiple myeloma
MPN Myeloproliferative neoplasm
OMF Osteomyelofibrosis
PM Polymyositis
PNP Polyneuropathy
S. Koeppen (*): A. Thirugnanasambanthan
Department of Neurology, Medical School, Un.
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Cjn.05780616.full lupus
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AML ASH SAP 6th edition
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Neurologic Complications of Hematologic Malignancies
- 1. Neurologic Complications of Hematologic Malignancies Ade Wijaya, MD – September 2018
- 2. Introduction Neoplasms in a leukemic phase are more likely to directly affect CNS. Lymphoid neoplasms that assume a more diffuse appearance are more likely to cause direct CNS complications compared with those of a more follicular (nodular) architecture. Acute leukemias (especially lymphoblastic type) have the highest propensity to be present at diagnosis and to relapse solely in the CNS. Hodgkin disease infrequently invades the CNS; neurologic complaints are therefore more likely secondary to extradural compressions or an indirect effect. ‘‘Paraneoplastic’’ syndromes tend to occur more frequently in plasma cell dyscrasias and Hodgkin disease. Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurologic clinics. 2003 Feb 1;21(1):87-105.
- 3. Hematologic malignancies that commonly affect neurologic system Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurologic clinics. 2003 Feb 1;21(1):87-105.
- 4. Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurologic clinics. 2003 Feb 1;21(1):87-105.
- 5. Leptomeningeal Infiltration Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurologic clinics. 2003 Feb 1;21(1):87-105.
- 6. Extradural Disease Recht L, Mrugala M. Neurologic complications of hematologic neoplasms. Neurologic clinics. 2003 Feb 1;21(1):87-105.
- 7. CNS Prophylaxis After chemotherapy era, duration of remission . CNS involvement became more common, its incidence increasing from 4% to 40% between 1947 and 1960 Prophylaxis irradiation 2400 cGy, incidence decrease to 4 % Similar result with intrathecal chemotherapy The tumors that are most likely to develop this complication are the aggressive B-cell non-Hodgkin lymphomas, such as lymphoblastic and Burkitt subtypes CNS involvement predictors: young age (<40 years), lymphoblastic and noncleaved cell type histologies, and advanced stage, with an estimated probability of developing meningeal involvement as high as 60% when all three were present Litam JP, Cabanillas F, Smith TL. Central nervous system relapse in malignant lymphomas: risk factors and implications for prophylaxis. Blood 1979;54:1249–57 Evans AE. Central nervous system involvement in children with leukemia. Cancer 1964;17:256–8. Sullivan MP, Chen T, Dyment PG, et al. Equivalence of intrathecal chemotherapy and radiotherapy as central nervous system prophylaxis in children with acute lymphatic leukemia: a Pediatric Oncology Group study. Blood 1982;60:948–58. Skarin AT, Rosenthal DS, Moloney WC, et al. Combination chemotherapy of advanced non-Hodgkin’s lymphoma with bleomycin, adriamycin, cyclophosphamide, vincristine, and prednisone (BACOP). Blood 1977;49:759–70. Ersboll J, Schultz HB, Thomsen B, et al. Meningeal involvement in non-Hodgkin’s lymphoma: symptoms, incidence, risk factors and treatment. Scand J Hematol 1985; 35:487–96.
- 8. Summary After chemotherapy era, neurologic involvement is more common Direct vs indirect mechanism Prophylaxis with irradiation or intrathecal chemotherapy