Bone Marrow Grafting Selectively Induces the Production of Acetylcholine Receptor Antibodies, Immunoglobulins Bearing Related Idiotypes, and Antiidiotypic Antibodies

Lefvert, Ann Kari; Bolme, Per; Hammarström, Lennart; Lönnqvist, B; Ringdé, Olle; Slördahl, Sofie H.; Cm, Smith

doi:10.1111/j.1749-6632.1987.tb51382.x

Cited by 8 publications

(4 citation statements)

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“…The incidence of MG is increased at least 20 times after BMT compared to that seen in the general population. 4 We described here the 15th such case. [1][2][3][4][5][6][7][8][9][10][11][12] However, this figure is most probably an underestimate since fatigue is a common manifestation of chronic GVHD and treatment of chronic GVHD should be effective in suppressing symptoms of MG in mild cases.…”

Section: Discussionmentioning

confidence: 91%

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, this figure is most probably an underestimate since fatigue is a common manifestation of chronic GVHD and treatment of chronic GVHD should be effective in suppressing symptoms of MG in mild cases. 4 It is not known which BMT patients are at risk of MG. 3,6,8,10 Idiopathic MG is age-and sex-related, with one peak incidence affecting mostly women in the second and third decades and another mostly men in the sixth and seventh decades. 13 An HLA haplotype with B8/DR3 has been associated with early-onset MG, B7/DR2 and late-onset MG and B35/DR1 with penicillamine-induced MG.…”

Section: Discussionmentioning

confidence: 99%

“…4 The diagnosis of MG is based on a typical clinical picture, a characteristic electromyographic pattern, a positive response to cholinesterase inhibitors, and the presence of AchRab. 13 A clinical classification has been proposed, based on the distribution and severity of symptoms: group 1, ocular; group 2A, mild generalized; group 2B, moderately severe generalized; group 3, acute fulminating; group 4, late severe.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12] In all these cases other signs of chronic graft-versus-host disease (GVHD) developed during the post-transplant period and antibodies to the acetylcholine receptor (AchRab) were always positive when tested. We report a new case of BMT-associated MG which developed shortly after cessation of immunosuppressive therapy without any other sign of GVHD and without AchRab.…”

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confidence: 99%

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Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Baron

Sadzot

Wang

et al. 1998

Bone Marrow Transplant

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Summary:A 20-year-old man with aplastic anemia developed myasthenia gravis (MG) 7 months after bone marrow transplantation (BMT) from an HLA one locusmismatched sister. Proximal muscle weakness (predominant in the lower limbs) and dysphagia occurred without any other sign of graft-versus-host disease (GVHD), 1 month after cessation of immunosuppression with cyclosporine. The diagnosis of MG was based on clinical symptoms and on neurophysiologic investigations showing a significant increase of the Jitter in single-fiber electromyography and a significant decremental response during repetitive stimulation at slow rates, but antibodies against the acetylcholine receptor (AchRab) were negative. All clinical and neurophysiological signs normalized within 1 month of treatment with low-dose prednisolone and pyridostigmine, and the patient is perfectly well 1 year after cessation of all therapy. All cases of BMT-associated MG previously published are reviewed in comparison with ours. The originality of this new observation is that this case is the only one not associated with chronic GVHD and negative for AchRab. Alternatively, MG may have been the sole manifestation of chronic GVHD in this patient.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Baron

Sadzot

Wang

et al. 1998

Bone Marrow Transplant

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Neurological Complications of Hematopoietic Cell Transplantation

Openshaw¹

2003

Thomas' Hematopoietic Cell Transplantation

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Muscle‐specific kinase (MuSK) antibody‐associated myasthenia gravis after bone marrow transplantation

Atassi

Amato

2008

Muscle and Nerve

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There have been 20 reported cases of myasthenia gravis (MG) following bone marrow transplantation (BMT) ( Table 1). 1,4,8,10,13,15,16 Acetylcholine receptor antibodies (AchR-ab) were present in 18 cases. We report the first case of BMT-associated MG with antibodies directed against muscle-specific tyrosine kinase (MuSK-ab). CASE REPORTA 54-year-old woman was diagnosed with non-Hodgkin lymphoma in February 2003, she was treated with chemotherapy, and followed by an allogeneic BMT. Since then she has been in remission and has never had graft-versushost disease (GVHD).In March 2006 she developed generalized weakness, diplopia, dysphagia, and an aspiration pneumonia. Following treatment of the pneumonia there was difficulty weaning from the ventilator. Neurological exam revealed ptosis, ophthalmoplegia, and severe proximal weakness. Motor and sensory nerve conduction studies were unremarkable. Needle electromyography revealed short duration, decreased amplitude motor unit potentials. Repetitive nerve stimulation at 3 Hz of the spinal accessory nerve revealed a 29% decrement at baseline, a 12% decrement after 10 sec of exercise, and a 48% decrement following 1 min. AchR-abs were absent, but MuSK-abs were detected.She was treated with plasmapheresis, solumedrol, and pyridostigmine and eventually discharged on prednisone 40 mg daily and cyclosporine 50 mg twice daily. She improved significantly over the next year but had occasional ptosis and mild residual proximal weakness. She was eventually tapered off prednisone.

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Bone Marrow Grafting Selectively Induces the Production of Acetylcholine Receptor Antibodies, Immunoglobulins Bearing Related Idiotypes, and Antiidiotypic Antibodies

Cited by 8 publications

References 1 publication

Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Neurological Complications of Hematopoietic Cell Transplantation

Muscle‐specific kinase (MuSK) antibody‐associated myasthenia gravis after bone marrow transplantation

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