Abstract Details

Title Immune Mediated Neuropathy Following Bone Marrow Transplantation

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 148

Objective

Background BACKGROUND: Cases of IMN following BMT have been reported in the literature, but there is no systematic review of IMN following BMT.

Design/Methods 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 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 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, FAAN (Mayo Clinic)	Dr. Dyck has nothing to disclose.
Michelle L. Mauermann, MD, FAAN (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, FAAN (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, FAAN (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.

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