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Co-occurrence of Multiple Sclerosis and Severe Aplastic Anemia: A Report of Two Cases Successfully Treated with Allogeneic Hematopoietic Stem Cell Transplantation. Clin Hematol Int 2023:10.1007/s44228-023-00028-8. [PMID: 36797548 DOI: 10.1007/s44228-023-00028-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/31/2022] [Indexed: 02/18/2023] Open
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2
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Deng R, Wu Y, Xu L, Liu K, Huang X, Zhang X. Clinical risk factors and prognostic model for idiopathic inflammatory demyelinating diseases after haploidentical hematopoietic stem cell transplantation in patients with hematological malignancies. Am J Hematol 2021; 96:1407-1419. [PMID: 34350623 DOI: 10.1002/ajh.26312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 01/09/2023]
Abstract
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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Affiliation(s)
- Rui‐Xin Deng
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Ye‐Jun Wu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Lan‐Ping Xu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Kai‐Yan Liu
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Jun Huang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
| | - Xiao‐Hui Zhang
- Peking University People's Hospital Peking University Institute of Hematology Beijing China
- Collaborative Innovation Center of Hematology Peking University Beijing China
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation Beijing China
- National Clinical Research Center for Hematologic Disease Beijing China
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3
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Li M, Zhang Y, Guan Y, Zhang Z, Dong H, Zhao Y, Deng H. A Case Report of Central Nervous System Graft-Versus-Host Disease and Literature Review. Front Neurol 2021; 12:621392. [PMID: 33776885 PMCID: PMC7987907 DOI: 10.3389/fneur.2021.621392] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/18/2021] [Indexed: 12/16/2022] Open
Abstract
As an adverse immune phenomenon, graft-versus-host disease often occurs after allogeneic hematopoietic stem cell transplantation. The incidence of acute and chronic graft-versus-host disease is about 40–60% and the mortality rate can reach 15%, which is a potentially fatal disease. There are rare GvHD cases involving the central nervous system. We reported a rare case of diffuse white matter changes after haploid bone marrow transplantation, summarizing its clinical manifestations and diagnosis and treatment in conjunction with the literature.
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Affiliation(s)
- Mingming Li
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Yue Zhang
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Yujia Guan
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Zunwei Zhang
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Hanbing Dong
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Yang Zhao
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
| | - Hui Deng
- Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China
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4
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Kaito Y, Yui S, Inai K, Onai D, Kinoshita R, Yamanaka S, Okamoto M, Wada R, Ohashi R, Inokuchi K, Yamaguchi H. Central Nervous System-related Graft-versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation. Intern Med 2021; 60:3299-3304. [PMID: 34657908 PMCID: PMC8580761 DOI: 10.2169/internalmedicine.6351-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Allogeneic hemopoietic stem cell transplantation (allo-HSCT) is the only curative therapy for refractory hematological malignancies. However, there are many treatment-related complications, including organ disorders, graft-versus-host disease (GVHD), and infectious diseases. Furthermore, there are many unclear points regarding central nervous system (CNS) complications, and the prognosis in patients with CNS complications is extremely poor. We herein report a 49-year-old woman who developed CNS-GVHD after a second transplantation for therapy-related myelodysplastic syndrome. CNS-GVHD in this case was refractory to all treatments, including steroids, and progressed. We also present a review of the literature about the symptoms, diagnosis, and treatment of CNS-GVHD.
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Affiliation(s)
- Yuta Kaito
- Department of Hematology, Nippon Medical School, Japan
| | - Shunsuke Yui
- Department of Hematology, Nippon Medical School, Japan
| | - Kazuki Inai
- Department of Hematology, Nippon Medical School, Japan
| | - Daishi Onai
- Department of Hematology, Nippon Medical School, Japan
| | | | | | - Muneo Okamoto
- Department of Hematology, Nippon Medical School, Japan
| | - Ryuichi Wada
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Japan
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5
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A case of central nervous system graft-versus-host disease following allogeneic stem cell transplantation. Int J Hematol 2019; 110:635-639. [PMID: 31309419 DOI: 10.1007/s12185-019-02702-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 12/27/2022]
Abstract
Graft-versus-host disease (GVHD) is a serious complication of allogeneic stem cell transplantation (SCT). Here, we report a rare case of GVHD involving the central nervous system (CNS). A 35-year-old woman was diagnosed with myelodysplastic syndrome unclassifiable and underwent allogeneic peripheral blood SCT for disease progression to myelodysplastic syndrome with excess blasts-2. One year following SCT, she experienced chronic oral and hepatic GVHD symptoms, which were managed with oral steroids and tacrolimus. Sixteen months after SCT, she developed sudden-onset, generalized, tonic-clonic-type seizures. Magnetic resonance imaging and cerebrospinal fluid evaluation showed multiple discrete white lesions and elevated IgG levels. Brain biopsy revealed periventricular plaques with the destruction of axons, representing a demyelinating disease of the CNS. We diagnosed the case as CNS GVHD. Neurologic symptoms gradually improved with methylprednisolone pulse therapy and total plasma exchange combined with a calcineurin inhibitor; the brain lesions nearly disappeared after decreasing steroid maintenance dosage, and were completely resolved 1 year after the onset of CNS GVHD. The patient is CNS GVHD-symptom-free, 3-year post-transplantation. Thus, CNS GVHD should be considered in cases of newly developed neurologic symptoms in SCT recipients showing evidence of preceding chronic GVHD.
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6
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Ruggiu M, Cuccuini W, Mokhtari K, Meignin V, Peffault de Latour R, Robin M, de Fontbrune FS, Xhaard A, Socié G, Michonneau D. Case report: Central nervous system involvement of human graft versus host disease: Report of 7 cases and a review of literature. Medicine (Baltimore) 2017; 96:e8303. [PMID: 29049232 PMCID: PMC5662398 DOI: 10.1097/md.0000000000008303] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Central nervous system (CNS) involvement of graft versus host disease (GvHD) is a rare cause of CNS disorders after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Chronic CNS GvHD symptoms are heterogeneous and include cerebrovascular manifestations, demyelinating disease and immune-mediated encephalitis. CNS-Acute GvHD is not formally defined in literature. PATIENTS CONCERNS AND DIAGNOSES We report 7 cases of CNS-GvHD among which two had histological-proven disease. We reviewed 32 additional cases of CNS GvHD published in literature since 1990. In this cohort, 34 patients were transplanted for hematologic malignancies, and 5 for non-malignant hematopoiesis disorders. Of these patients, 25 had a history of chronic GvHD and immunosuppressive treatment had been decreased or discontinued in 14 patients before neurological symptoms onset. Median neurological disorder onset was 385 days [7-7320]. Patients had stroke-like episodes (n = 7), lacunar syndromes (n = 3), multiple sclerosis-like presentations (n = 7), acute demyelinating encephalomyelitis-like symptoms (n = 4), encephalitis (n = 14), mass syndrome (n = 1), and 3 had non-specific symptoms. Median neurological symptoms onset was 81.5 days [7-1095] for patients without chronic GVHD history versus 549 days [11-7300] for patients with chronic GVHD (P = 0.001). Patients with early involvement of CNS after allo-HSCT and no chronic GVHD symptoms were more frequently suffering from encephalitis (64% versus 28%, P = 0.07), whereas stroke-like episodes and lacunar symptoms were less frequent (9% versus 36%, P = 0.13). INTERVENTIONS 34 patients with CNS-GvHD were treated with immunosuppressive therapy, including corticosteroids for 31 of them. Other treatments were intravenous immunoglobulin, plasmapheresis, cyclophosphamide, calcineurin inhibitors, mycophenolic acid, methotrexate and etoposide. OUTCOMES 27 patients achieved a response: 10 complete responses, 15 partial responses and 2 transient responses. Of 25 patients with sufficient follow-up, 7 were alive and 18 patients deceased after CNS-GvHD diagnosis. LESSONS CNS-related GvHD is a rare cause of CNS disorders after allo-HSCT and is associated with a poor prognosis.
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Affiliation(s)
- Mathilde Ruggiu
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
| | - Wendy Cuccuini
- Université Paris Diderot, Sorbonne Paris Cité
- Laboratoire de Cytogénétique, Hôpital Saint Louis
| | - Karima Mokhtari
- Laboratoire d’anatomie pathologique, Hôpital La Pitié Salpétrière, APHP
- Université Pierre et Marie Curie, Sorbonne Paris Cité
| | - Véronique Meignin
- Université Paris Diderot, Sorbonne Paris Cité
- Laboratoire d’Anatomie Pathologique, Hôpital Saint Louis, APHP
| | - Régis Peffault de Latour
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
- EA3518, Université Paris Diderot
| | - Marie Robin
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
- INSERM U1131, Université Paris Diderot
| | - Flore Sicre de Fontbrune
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
| | - Aliénor Xhaard
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
| | - Gérard Socié
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
- INSERM UMR1160, Institut Universitaire d’Hématologie, Centre Hayem, Paris, France
| | - David Michonneau
- Service d’Hématologie Greffe, Hôpital Saint Louis, APHP
- Université Paris Diderot, Sorbonne Paris Cité
- INSERM UMR1160, Institut Universitaire d’Hématologie, Centre Hayem, Paris, France
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7
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Yamada S, Takatsuka H, Takemoto Y, Mori A, Wada H, Fujimori Y, Okamoto T, Kanamaru A, Kakishita E. Similarity Between Multiple Sclerosis and Idiopathic Central Nervous System Dysfunction After Bone Marrow Transplantation. Hematology 2016; 6:125-9. [DOI: 10.1080/10245332.2001.11746562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Shinji Yamada
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Hiroyuki Takatsuka
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Yoshinobu Takemoto
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Ako Mori
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Hiroshi Wada
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Yoshihiro Fujimori
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Takahiro Okamoto
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
| | - Akihisa Kanamaru
- Third Department of Internal Medicine, Kinki University School of Medicine, Osaka, Japan
| | - Eizo Kakishita
- Second Department of Internal Medicine, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinimiya, Hyogo 663-8501, Japan
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8
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Takatsuka H, Wakae T, Mori A, Okada M, Fujimori Y, Takemoto Y, Okamoto T, Sugihara A, Terada N, Kanamaru A, Kakishita E. Superior Vena Cava Syndrome after Bone Marrow Transplantation Caused by Aspergillosis: A Case Report. Hematology 2013; 7:169-72. [PMID: 12243980 DOI: 10.1080/1024533021000008137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aspergillosis is known for the variety of unusual presentations in immuno-suppressed patients. We report a patient in whom aspergillosis caused the superior vena cava (SVC) syndrome. A 37-year-old woman became febrile soon after bone marrow transplantation (BMT). Chest radiography demonstrated a 5-cm mass extending from the right lung apex to the right supraclavicular fossa beside her Hickman catheter. She then developed SVC syndrome, which progressed despite treatment. Despite recovery of the white blood cell count, the patient continued to deteriorate, became comatose, suffered a cardiac arrest and died 31 days after BMT. Autopsy revealed Aspergillus infection at the apex of the right lung associated with innominate artery thrombosis.
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Affiliation(s)
- H Takatsuka
- Second Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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9
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Saad AG, Alyea EP, Wen PY, Degirolami U, Kesari S. Graft-versus-host disease of the CNS after allogeneic bone marrow transplantation. J Clin Oncol 2009; 27:e147-9. [PMID: 19667266 DOI: 10.1200/jco.2009.21.7919] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ali G Saad
- Department of Pathology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA
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10
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Large vessel vasculitis: manifestation of graft-versus-host disease? J Neurol 2009; 256:1947-9. [DOI: 10.1007/s00415-009-5272-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 07/21/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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11
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Matsuo Y, Kamezaki K, Takeishi S, Takenaka K, Eto T, Nonami A, Miyamoto T, Iwasaki H, Harada N, Nagafuji K, Teshima T, Akashi K. Encephalomyelitis mimicking multiple sclerosis associated with chronic graft-versus-host disease after allogeneic bone marrow transplantation. Intern Med 2009; 48:1453-6. [PMID: 19687597 DOI: 10.2169/internalmedicine.48.2003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe a case of encephalomyelitis mimicking multiple sclerosis associated with chronic graft-versus-host disease (GVHD) occurring after allogeneic bone marrow transplantation (BMT) for myelodysplastic syndrome. Immunosuppressive therapy, consisting of a therapeutic dose of cyclosporine A and a maintenance dose of methylprednisolone, was effective in treating symptoms. Although central nervous system GVHD is very rare and remains controversial, presentation of neurological symptoms after allogeneic BMT warrants consideration of GVHD in the differential diagnosis.
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Affiliation(s)
- Yayoi Matsuo
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka
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12
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Abstract
Hematopoietic-cell transplantation (HCT) has become applicable to a broader range of ages and underlying diagnoses through advances in the utilization of alternative donors and stem-cell sources, reduced-intensity preparative regimens, and improved supportive care. The reduction in early transplant-related mortality means that more survivors will potentially develop chronic graft-versus-host disease (cGVHD) and associated late effects. Recipients of HCT are at risk for late end-organ dysfunction as a complication of chemoradiotherapy given before HCT, but disturbances are often multifactorial. This review focuses on problems arising predominantly as a result of cGVHD and its therapies. Disabilities caused by severe or inadequately treated cGVHD include keratoconjunctivitis sicca, bronchiolitis obliterans, skin ulcers, joint contractures, esophageal and vaginal stenosis, osteoporosis, avascular necrosis, and others. Almost all organ systems may be involved, and a broad approach is needed to allow recognition and anticipation of problems so that prevention or early intervention is possible.
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Affiliation(s)
- Paul A Carpenter
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Mailstop D5-290, Seattle, WA 98107, USA.
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13
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Steroid-responsive cauda equina syndrome associated with GVHD after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2007; 41:315-6. [DOI: 10.1038/sj.bmt.1705915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Kamble RT, Chang CC, Sanchez S, Carrum G. Central nervous system graft-versus-host disease: report of two cases and literature review. Bone Marrow Transplant 2006; 39:49-52. [PMID: 17099715 DOI: 10.1038/sj.bmt.1705540] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Two patients with a plausible diagnosis of central nervous system graft-versus-host disease (CNS-GVHD) are described. Both presented with neurological manifestations 6 and 18 months following allogeneic transplant with hemiparesis, seizure, encephalopathy and magnetic resonance findings of hyperintense white matter lesions on T-2 weighed images. Brain biopsy in one and autopsy in the other revealed profound perivascular lymphocytic infiltrates composed predominantly of T-lymphocytes that were of donor origin. Although an unequivocal diagnosis of CNS-GVHD is difficult to establish, the transplantation community should be aware of this controversial entity.
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Affiliation(s)
- R T Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine and Methodist Hospital, Houston, TX 77030, USA.
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15
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Abstract
Acute graft-versus-host disease (GVHD), initiated by the reaction of donor T lymphocytes against nonshared recipient antigens, typically leads to a clinical syndrome characterized by cutaneous eruptions and intestinal and hepatic dysfunction. These three organ systems are considered in the clinical grading of acute GVHD. However, other targets may be involved. With conventional transplant conditioning regimens and in vivo prophylaxis, GVHD becomes clinically manifest within 2 to 4 weeks. With reduced-intensity conditioning, the onset of acute GVHD may be delayed until 2 to 3 months after transplantation. Hyperacute GVHD may occur within a week of transplantation after severely human leukocyte antigen (HLA)-mismatched transplants or transplants without GVHD prophylaxis. There is no reliable laboratory test for acute GVHD, and the diagnosis is based on clinical assessment.
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Affiliation(s)
- H Joachim Deeg
- Fred Hutchinson Cancer Research Center, Seattle WA 98109-1024, USA.
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16
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Deeg HJ, Flowers MED. Impact of chronic GVHD on late complications after hematopoietic cell transplantation. Hematology 2005; 10 Suppl 1:245-9. [PMID: 16188683 DOI: 10.1080/10245330512331389872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- H Joachim Deeg
- Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, WA 98109-1024, USA.
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17
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Guermazi A, Miaux Y, Lafitte F, Zahar JR, Gluckman E. CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies. Eur Radiol 2003; 13 Suppl 4:L202-14. [PMID: 15018188 DOI: 10.1007/s00330-003-1949-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The purpose of this article is to present the imaging appearance of central nervous system effects of therapy that may occur in patients treated for hematological malignancies. Imaging in these patients relates to complications of high-dose therapy, bone marrow transplantation, infections occurring in immunocompromised patients, central nervous system dysfunction due to failure of other organ systems, or cerebral hemorrhages due to platelet refractoriness. Rapid and accurate diagnosis is essential but often difficult, as neurological manifestations are rarely disease specific. Neurological imaging, in combination with electrophysiological studies as well as blood and cerebrospinal fluid investigations, may be helpful for diagnosing most of these complications, as well as in differentiating between the manifestations of the underlying disease and complications of the treatment.
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Affiliation(s)
- Ali Guermazi
- Department of Radiology, Saint-Louis Hospital AP-HP, Paris, France.
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