Immune-Mediated Myelopathy following Allogeneic Stem Cell Transplantation

Abstract

We report a case of immune-mediated myelopathy occurring 4 months after unrelated bone marrow transplantation for myelodysplastic syndrome. After the tapering of cyclosporine for graft-versus-host disease prophylaxis, the patient developed several neurological symptoms mimicking the clinical features of multiple sclerosis (MS). Although neurological exacerbation was well stabilized with a bulk dose of corticosteroid, sustained improvement of neurological deficits occurred after the patient developed hematopoietic mixed chimerism (HMC). This experience may provide clinical evidence supporting the current therapeutic concept, in which HMC induction can potentially cure several immune diseases, including MS.

A Case of Multiple Sclerosis—Like Relapsing Remitting Encephalomyelitis Following Allogeneic Hematopoietic Stem Cell Transplantation and a Review of the Published Literature

“…Reported cases of CNS demyelinating disorders following allogeneic HSCT are very limited. Tables 1, 2 summarize 20 such cases that have been reported in the literature (5)(6)(7)(8)(12)(13)(14)(15)(16)(17)(18)(19). The median age of receiving allogeneic HSCT was 45.5 (range, 17-65) years and the median interval between HSCT and the onset of CNS demyelination was 1 (range, 0.1-8) year.…”

Treatment of radiculomyelopathy in two patients with placenta-derived decidua stromal cells

“…The occurrence of GVHD in the CNS is debated, but the affection of the brain, and also the spinal cord (myelopathy), has been described [17,18]. Causes other than GVHDinduced myelopathy (myelitis) were excluded by a thorough workup of possible viral and infectious factors in blood and CSF, and also by ruling outside effects of drugs.…”

Encephalomyelitis Mimicking Multiple Sclerosis Associated with Chronic Graft-Versus-Host Disease after Allogeneic Bone Marrow Transplantation

“…Although GVHD commonly affects the skin, gastrointestinal tract, liver, and hematopoietic system, recent reports have described patients with neurologic manifestations associated with GVHD (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Animal studies support the possibility of the brain being a target organ for GVHD (15) …”