Polymyositis as a Manifestation of Chronic Graft-Versus-Host Disease

Parker, Pablo; Chao, Nelson J.; Ben-ezra, Johnathan; Slatkin, Neal; Openshaw, Harry; Niland, Joyce C.; Linker, Charles; Greffe, Brian; Kashyap, Ashwin; Molina, Arturo; Nademanee, Auayporn; O’Donnell, Margaret; Planás, Ina; Sheibani, Khalil; Smith, Eileen; Snyder, David S.; Spielberger, Ricardo; Stein, Anthony S.; Stepan, Daniel E.; Blume, Karl G.; Forman, Stephen J.

doi:10.1097/00005792-199609000-00004

Cited by 78 publications

(65 citation statements)

References 14 publications

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“…Janin et al 7 reported that 14 out of 475 patients (2.9%) who underwent Allo-BMT from an HLA-identical sibling donor developed fasciitis. Parker et al 10 also showed that the rate of polymyositis among patients who developed chronic GVHD after Allo-BMT from a sibling donor was 3.4%. In this study, only one patient, who underwent R-BMT from an HLA-single locus mismatched donor, developed fasciitis out of 645 R-BMT recipients.…”

Section: Discussionmentioning

confidence: 98%

“…7 In myositis, some reported cases showed a recurrence with either a reduction or cessation of immunosuppressant therapy. [10][11][12]20 One of our patients also had recurrent acute myositis after CsA was tapered, and achieved a second remission of polymyositis with CsA. 20 We need to recognize that both fasciitis and myositis caused by chronic GVHD can result in disabilities that reduce the patient's QOL.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with chronic GVHD have decreased performance status, impaired quality of life (QOL) and an increased risk of mortality. 5,6 Muscle-related complications, fasciitis [7][8][9] and myositis [10][11][12][13] are relatively rare chronic GVHD manifestations, and their clinical features resemble autoimmune eosinophilic fasciitis and idiopathic polymyositis. The new chronic GVHD diagnostic guidelines proposed fasciitis as diagnostic, and myositis as a distinctive sign and symptom of chronic GVHD manifestation.…”

Section: Introductionmentioning

confidence: 99%

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Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT

Oda

Nakaseko

Ozawa

et al. 2008

Bone Marrow Transplant

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The muscle-related complications of fasciitis and myositis, caused by chronic GVHD after Allo-SCT are relatively rare, but at times will severely impair a patient's quality of life (QOL). We performed a retrospective analysis in Japanese Allo-SCT recipients to identify the incidence, risk factors and clinical features of fasciitis and myositis. In 1967 patients who underwent Allo-SCT between January 1994 and March 2005 and survived beyond 90 days post transplantation, eight patients developed fasciitis and nine patients developed myositis, with a 5-year cumulative incidence of 0.55% and 0.54%, respectively. The median time from SCT to the development of fasciitis and myositis was 991 and 660 days, respectively. PBSCT was a risk factor for developing fasciitis, but no risk factors were found for myositis. The response to immunosuppressive treatment was better in patients with myositis than fasciitis, and the overall survival after developing these symptoms was better in patients with myositis than those with fasciitis. An early diagnosis by a biopsy, which includes fascia and muscle or magnetic resonance imaging (MRI) and prompt treatment may be important to prevent an impairment of the patient's QOL with persistent disability.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT

Oda

Nakaseko

Ozawa

et al. 2008

Bone Marrow Transplant

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“…The most common presenting symptoms are moderate to severe proximal muscle weakness and myalgias. 11 Lower extremities seem to be more commonly involved. 15,26,27 Other signs and symptoms may include fever, 2,20,27,28 contractures, 2,18,23,26 dysphagia 14,24 eosinophilia 13,21 and skin induration over the areas of muscle involvement.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] We report two cases of chronic GVHD presenting with polymyositis manifestations 13 and 19 months after allogeneic hematopoietic stem cell transplant, successfully treated with corticosteroids and tacrolimus.…”

mentioning

confidence: 99%

Chronic graft-versus-host disease manifesting as polymyositis: an uncommon presentation

Couriel

Beguelin

Giralt

et al. 2002

Bone Marrow Transplant

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Summary:Graft-versus-host disease (GVHD) remains a major complication of allogeneic hematopoietic stem cell transplantation. Polymyositis can occur in association with chronic GVHD and mimics the idiopathic form of the disease. We report two cases of chronic GVHD-associated polymyositis and review the published literature. The two patients presented 13 and 19 months after allogeneic transplantation with characteristic features of muscular hypotrophy, proximal muscle weakness, pain, elevated creatine phosphokinase (CPK), aldolase and SGPT. Interestingly, both patients had HLA DR52 genes, which is frequently reported in association with idiopathic polymyositis. Electromyogram (EMG) and muscle biopsy confirmed the diagnosis. Treatment with cyclosporine or tacrolimus resulted in complete and sustained remission of polymyositis in both cases. A review of the literature shows cyclosporine and steroids are well-described treatment options for patients with myositis in post transplant, as well as idiopathic cases. The duration of immunosuppressive treatment has varied in different reports, and there is a risk of recurrence when immunosuppression is tapered.

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Rehabilitation following bone marrow transplantation

Gillis¹,

Donovan²

2001

Cancer

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Bone marrow transplantation and stem cell transplantation are increasingly used to treat hematologic malignancies and some solid tumors. The treatment entails bone marrow–ablative therapies and intensive medical support to sustain the patient through pancytopenia and other complications of the disease, transplantation process, or drug side effects. Patients who develop graft‐versus‐host disease are the most difficult subset of transplant recipients to manage. Most transplant recipients perform at normal or near‐normal functional levels at the inception of the transplantation process but are at high risk for developing functional deficits as a result of cumulative impairments. These impairments arise from their disease, their prior cancer treatment, transplant induction, graft‐versus‐host disease, immobility, infection, steroid‐related side effects, and other sequelae of transplantation. Preventive and preemptive rehabilitation interventions can minimize functional loss and facilitate recovery, but the transplantation team must be sensitive to and regularly assess for early functional declines in these patients. The physiatrist and the other members of the rehabilitation team must be thoroughly acquainted with the unique needs and challenges of the bone marrow transplantation population in order to design and modify treatment programs effectively and safely. Outcome research has shown that some patients have continued limitations in function despite successful transplantation. Few evidence‐based data are available that addresses factors correlating with poor functional outcomes other than graft‐versus‐host disease. However, this disease has not been investigated utilizing objective functional instruments. Future research should more clearly elucidate the functional impact of allogeneic and autologous transplants by using standardized physical performance measures as well as thorough function‐based symptomatology questionnaires. Cancer 2001;92:998–1007. © 2001 American Cancer Society.

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Polymyositis as a Manifestation of Chronic Graft-Versus-Host Disease

Cited by 78 publications

References 14 publications

Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT

Fasciitis and myositis: an analysis of muscle-related complications caused by chronic GVHD after allo-SCT

Chronic graft-versus-host disease manifesting as polymyositis: an uncommon presentation

Rehabilitation following bone marrow transplantation

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