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Abstract Details

Immune Mediated Neuropathy Following Bone Marrow Transplantation
Peripheral Nerve
P01 - (-)
148
BACKGROUND: Cases of IMN following BMT have been reported in the literature, but there is no systematic review of IMN following BMT.
DESIGN/METHODS: We reviewed the charts of all patients with BMT at our institution between January 1997 and August 2012. Patients with IMN following BMT were selected. Patients with non-immune polyneuropathy (treatment-emergent, neoplastic infiltration) or IMN prior to BMT were excluded.
RESULTS: Of the 3305 patients who underwent BMT, 12 patients (0.36%) had IMN. Patients' mean age was 54 years. Nine patients were men. The mean time from BMT to IMN was 12 months (range 5 days to 58 months). Neuropathy phenotypes included: 4 Guillain-Barre syndromes, 4 asymmetric plexopathies, 3 asymmetric polyradiculoneuropathies and 1 multiple mononeuropathy. EMG showed demyelinating neuropathy in 4 patients and axonal neuropathy in 8. Nerve biopsy was performed in one and showed demyelination. CSF protein was increased in 5 of 6 patients. Underlying hematological diagnoses were: 6 Non-Hodgkin lymphomas, 3 acute myeloid leukemias (AML), 2 multiple myelomas and 1 myelodysplastic syndrome. Six patients had allogenic BMT. Neurological examination showed improvement with immunotherapy in 6 patients and spontaneously in 3. One patient died from IMN's complications. Two patients died from complications of their hematological disease. Five patients had recurrence of their malignancy within 4 months of the IMN and 4 of them died.
CONCLUSIONS: IMN are rare following BMT, but do occur. The pattern of neuropathy tends to be asymmetrical and non-length dependent. Most patients respond to immune therapy, however early relapse of their hematologic malignancy is common and carry a poor prognosis. The association of the early relapse of the underlying malignancy with the onset of neuropathy suggests that some of the IMNs are likely due to paraneoplastic neuropathy.
Authors/Disclosures
Chafic Y. Karam, MD (University of Pennsylvania)
PRESENTER 		Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alnylam. Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Nuvig. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Applied therapeutics. Dr. Karam has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Intellia. Dr. Karam has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Takeda. Dr. Karam has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Vertex.
No disclosure on file
No disclosure on file
Rajat Lahoria, MD No disclosure on file
Peter J. Dyck, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Dyck has nothing to disclose.
Michelle L. Mauermann, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) The institution of Dr. Mauermann has received research support from Intellia. Dr. Mauermann has received publishing royalties from a publication relating to health care.
P. James B. Dyck, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Dyck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Akcea/Ionis.
Douglas L. Arnold, MD, FÂ鶹´«Ã½Ó³»­ (Montreal Neurological Institute, McGill Univ) Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Frequency Therapeutics. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Arnold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Xfacto communications. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Find therapeutics. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GSK. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Idorsia. Dr. Arnold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniksa. Dr. Arnold has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Clario.