Summary:Guillain-Barré syndrome is a rare complication in the setting of hematopoietic stem cell transplantation. We report three children with T cell lymphoma/leukemia in whom this syndrome developed soon after they received unrelated donor transplants. The rapid onset of symptoms raises the concern that the bone marrow transplant conditioning regimen (ie, total body irradiation, cyclophosphamide and cytosine arabinoside) might have precipitated the clinical syndrome of ascending polyneuropathy. Although central nervous system toxicity has been well described with high-dose cytosine arabinoside therapy, peripheral neuropathy of the GuillainBarré type has been reported only infrequently. We review possible factors contributing to the development of this syndrome in these three patients. Bone Marrow Transplantation (2002) 29, 515-517. DOI: 10.1038/sj/bmt/1703412 Keywords: Guillain-Barré syndrome; polyneuropathy; hematopoietic stem cell transplantation Hematopoietic stem cell transplant (HSCT) recipients are at risk for neurologic complications. These neurologic effects may arise from the primary disease for which the patient is undergoing HSCT, from infection that may develop during the HSCT, or as a consequence of other treatment.1-3 Guillain-Barré syndrome (GBS) is an uncommon manifestation of neurotoxicity during HSCT and has usually been attributed to infection. 4 We report three cases of acquired peripheral ascending polyneuropathy, consistent with the diagnosis of GBS, that developed in the early post-transplant period.
Case reportsCase 1 A 16-year-old Caucasian boy was diagnosed as having T cell leukemia with central nervous system disease and was treated with a Pediatric Oncology Group (POG) protocol (POG 9404) that included craniospinal irradiation (1800 cGy). At week 84, he presented with a central nervous system relapse. The patient underwent three-drug reinduction and six consolidation courses of chemotherapy consisting of high-dose cytosine arabinoside (Ara-C) and triple intrathecal chemotherapy (methotrexate, Ara-C, hydrocortisone) alternating with vincristine, prednisone, and 6-mercaptopurine. He was referred to our institution for a 5/6 mismatched unrelated bone marrow donor transplant.HSCT conditioning therapy was administered according to protocol: Ara-C, 3 g/m 2 every 12 h for six doses on day −8 to day −5; cyclophosphamide, 45 mg/kg for two doses on days −7 and −6, and Mesna; antithymocyte globulin, 30 mg/kg on days −7, −6 and −5; and total body irradiation, 14.0 Gy divided into eight fractions per day beginning on day −4, with boosts to the cranium. For prophylaxis of graft-versus-host disease, the patient received cyclosporine starting on day −2, and the donor bone marrow underwent in vitro T cell depletion.
5On day −5, rhinorrea was noted and culture and enzyme immunoassay were positive for parainfluenza virus type 1 on nasal wash. Treatment with ribavirin and intravenous immunoglobulin (RespiGam) was initiated, and the respiratory symptoms and findings stabilized. On day +6, the patient c...