Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Baron, Frédéric; Sadzot, Bernard; Wang, François‐Charles; Béguin, Yves

doi:10.1038/sj.bmt.1701297

Cited by 21 publications

(18 citation statements)

References 7 publications

(13 reference statements)

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“…Several patients undergoing allogeneic bone marrow transplantation have developed MG as immunosuppressive therapy was tapered. 6 The role of T cells in the pathogenesis of MG is suggested by cellular and humoral responses measured as MG developed and then improved during the course of human immunodeficiency virus infection. 100 Thymoma.…”

Section: Associated Conditions Especially Thymomamentioning

confidence: 99%

Clinical evaluation and management of myasthenia gravis

2004

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Myasthenia gravis (MG) is a syndrome of fluctuating skeletal muscle weakness that worsens with use and improves with rest. Eye, facial, oropharyngeal, axial, and limb muscles may be involved in varying combinations and degrees of severity. Its etiology is heterogeneous, divided initially between those rare congenital myasthenic syndromes, which are genetic, and the bulk of MG, which is acquired and autoimmune. The autoimmune conditions are divided in turn between those that possess measurable serum acetylcholine receptor (AChR) antibodies and a smaller group that does not. The latter group includes those MG patients who have serum antibodies to muscle-specific tyrosine kinase (MuSK). Therapeutic considerations differ for early-onset MG, late-onset MG, and MG associated with the presence of a thymoma. Most MG patients can be treated effectively, but there is still a need for more specific immunological approaches.

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Section: Associated Conditions Especially Thymomamentioning

confidence: 99%

Clinical evaluation and management of myasthenia gravis

2004

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“…14,16,20 The pathogenesis of neuromuscular disorders after allogeneic transplants without clinical evidence of graft-versus-host disease or after autologous transplants remains puzzling. 2,5,23 We report four patients who developed acute peripheral nerve disorders between 5 days and 4 months after autologous peripheral blood stem cell or allogeneic bone marrow transplantation. These cases were identified from a population of 719 patients who underwent peripheral blood or bone marrow transplantation at the Mayo Clinic, Rochester, Minnesota (592 autologous and 127 allogeneic transplants), between January 2000 and December 2002. three courses of DHAP (dexamethasone, cytosine arabinoside, and cisplatin) and achieved a partial response.…”

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confidence: 99%

“…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.…”

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confidence: 99%

Acute neuropathies after peripheral blood stem cell and bone marrow transplantation

et al. 2003

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Neuromuscular complications are not uncommon after bone marrow and stem cell transplantation, especially in patients with allogeneic transplantations and graft-versus-host disease. The pathogenesis of these complications remains unclear, but the changes in immune modulation that occur after transplantation are likely to play a key role. We describe 4 patients who developed brachial plexopathy (3 cases) or multiple lumbosacral radiculopathies (1 case) between 5 days and 4 months after autologous peripheral blood stem cell (3 cases) or allogeneic bone marrow transplantation without evidence of graft-versus-host disease (1 case). Infectious, tumor-related, toxic, and metabolic causes were excluded in all cases. Recovery was limited in two cases and nearly complete in the other two patients. Brachial plexopathies and polyradiculopathies are potential complications of peripheral blood stem cell and bone marrow transplantation. It is possible that these disorders may be the result of autoimmune phenomena directed against specific nerve antigens.

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“…All of the patients reported in the literature except one have had active chronic GVHD, and many had recently decreased or discontinued their immunosuppression. [1][2][3][4][5][6][7][8][9][10][11][12] It has therefore been postulated that the development of myasthenia gravis following allogeneic BMT may be an unusual manifestation of chronic GVHD. Studies have shown that over 20% of patients who undergo allogeneic BMT develop autoantibodies to the acetylcholine receptor, but only a distinct minority of these patients go on to develop clinical evidence of myasthenia gravis.…”

Section: Discussionmentioning

confidence: 99%

Myasthenia gravis after allogeneic bone marrow transplantation for lymphoblastic lymphoma

Dowell

Moots

Stein

1999

Bone Marrow Transplant

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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-

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Myasthenia gravis without chronic GVHD after allogeneic bone marrow transplantation

Cited by 21 publications

References 7 publications

Clinical evaluation and management of myasthenia gravis

Clinical evaluation and management of myasthenia gravis

Acute neuropathies after peripheral blood stem cell and bone marrow transplantation

Myasthenia gravis after allogeneic bone marrow transplantation for lymphoblastic lymphoma

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