Myasthenia gravis after allogeneic bone marrow transplantation for lymphoblastic lymphoma

Abstract

Summary:A 31-year-old female with lymphoblastic lymphoma developed myasthenia gravis (MG) 26 months after receiving an allogeneic bone marrow transplant (BMT) from an HLA-identical sister. She presented with classic symptoms and electromyographic evidence of the disorder approximately 2 weeks after electing to abruptly discontinue her immunosuppressive medications. She initially responded to steroids and acetylcholinesterase inhibitors. Her subsequent course has been characterized by episodes of moderately severe weakness that respond to intravenous immunoglobulin and prednisone. This case of post-transplant MG is only the second reported to have occurred in association with BMT for lymphoblastic lymphoma. Potential risk factors for the development of post-transplant MG are discussed including underlying hematological disorder, HLA phenotype, family history of MG, the presence of chronic GVHD, and recent cessation of immune suppression. Keywords: myasthenia gravis; allogeneic bone marrow transplant; lymphoblastic lymphoma; graft-versus-host disease Case reportMyasthenia gravis is an autoimmune disorder characterized by skeletal muscle weakness and fatigability. The diagnosis is based on clinical presentation and is confirmed by the presence of antibodies to the acetylcholine receptor, a characteristic EMG pattern, and clinical improvement with the administration of acetylchoinesterase inhibitors. Myasthenia gravis has been reported following allogeneic BMT in patients with active chronic graft-versus-host disease (GVHD), and it is felt to be a rare manifestation of this disorder. We describe a patient with lymphoblastic lymphoma treated with allogeneic BMT who developed myas-

Neuromuskuläre Komplikationen nach allogener Knochenmarktransplantation

“…B. eine Glomerulonephritis oder Polymyositis -wurde kasuistisch berichtet [22,49]. Therapeutisch werden Cholinesterasehemmer, Steroide und IvIg eingesetzt, eine Empfehlung zu einer Thymektomie kann nicht ausreichend mit positiven Daten belegt werden [13,27].…”

Acute neuropathies after peripheral blood stem cell and bone marrow transplantation

“…3,15 The most commonly recognized complications include myasthenia gravis, 2,4,7,20 Guillain-Barré syndrome, 5,15,23 and polymyositis. 14,20,22 Isolated cases of peripheral neuropathy 3 and chronic inflammatory demyelinating polyradiculoneuropathy 1 have also been described.…”

A possible role of low regulatory T cells in anti-acetylcholine receptor antibody positive myasthenia gravis after bone marrow transplantation

“…Patients with aplastic anemia as a background would have an increased risk of developing MG after transplantation [11]. Patients with specific HLAs (HLA Cw1, Cw7 or DR2) and a family history of MG are also at an increased risk of developing MG after HSCT [12, 13]. However, none of these risk factors was identified in the present case.…”