title: Immune-mediated neuropathies following stem cell transplantation.
abstract: OBJECTIVE
  To study the clinical, electrophysiological and pathological characteristics and outcome of immune-mediated neuropathy (IMN) following stem cell transplantation (SCT).
  
  
  METHODS
  Retrospective chart review of the Mayo Clinic Rochester SCT database between January 1997 and August 2012.
  
  
  RESULTS
  Of the 3305 patients who underwent SCT, 12 patients (0.36%) had IMN. The median time from SCT to IMN was 7 months. IMN typically presented as an asymmetric radiculoplexus neuropathy (7/12 patients) or acute polyradiculoneuropathy (Guillain-Barré syndrome) (4/12). Neurophysiology showed demyelinating neuropathy in four patients and axonal neuropathy in eight. Cerebrospinal fluid protein was increased in five of six patients (median 67 mg/dL). The Neuropathy Impairment Score (NIS) improved in all patients (mean NIS 43-10, p=0.016). Six patients died. One patient died from complications of IMN and one died from complications of the haematological disease. Five patients had recurrence of their malignancy within 4 months of the IMN and of these, four died.
  
  
  CONCLUSIONS
  IMN occurs rarely in patients after SCT. Two possible mechanisms include (1) an immune reconstitution syndrome, supported by stereotypical neuropathy types (radiculoplexus and polyradiculoneuropathies), monophasic course and temporal association with SCT and (2) a paraneoplastic phenomenon, supported by frequent early malignancy recurrence following IMN.
authors.affiliation: Peripheral Nerve Division, Department of Neurology, Mayo Clinic Rochester, , Rochester, Minnesota, USA.
authors.forename: Chafic
authors.initials: C
authors.lastname: Karam
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Mauermann
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Johnston
authors.forename: Rajat
authors.initials: R
authors.lastname: Lahoria
authors.forename: Janean K
authors.initials: JK
authors.lastname: Engelstad
authors.forename: P James B
authors.initials: PJ
authors.lastname: Dyck
mesh_terms: D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000209:etiology*; D015551:Autoimmunity; D001706:Biopsy; D005260:Female; D020275:Guillain-Barre Syndrome / Q000276:immunology; D019337:Hematologic Neoplasms / Q000601:surgery; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D020361:Paraneoplastic Syndromes, Nervous System / Q000276:immunology; D011115:Polyneuropathies / Q000453:epidemiology / Q000209:etiology / Q000276:immunology*; D011129:Polyradiculoneuropathy / Q000276:immunology; D012189:Retrospective Studies; D012584:Sciatic Nerve / Q000473:pathology; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
keywords: GUILLAIN-BARRE SYNDROME; NEUROONCOLOGY; NEUROPATHY; PARANEOPLASTIC SYNDROME; PERIPHERAL NEUROPATHOLOGY