INCIDENCE, RISK FACTOR AND OUTCOME OF IMMUNE-MEDIATED NEUROPATHIES FOLLOWING HAPLOIDENTICAL HAEMATOPOIETIC STEM CELL TRANSPLANTATION
Author(s): ,
Xiying Ren
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Xiao Liu
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Qiusha Huang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Qianming Wang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yun He
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Xiaolu Zhu
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Wei Han
Affiliations:
Peking University People’s Hospital,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Huan Chen
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yuhong Chen
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Fengrong Wang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Jingzhi Wang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yuanyuan Zhang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Xiaodong Mo
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yao Chen
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yu Wang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Haixia Fu
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Yingjun Chang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Lanping Xu
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Kaiyan Liu
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
,
Xiaojun Huang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
Xiaohui Zhang
Affiliations:
Peking University Institute of Hematology,Peking University People’s Hospital,Beijing,China;Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,Beijing,China;Collaborative Innovation Center of Hematology,Peking University,Beijing,China
EHA Library. Ren X. Jun 15, 2019; 267148; PS1531
Xiying Ren
Xiying Ren
Contributions
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Abstract

Abstract: PS1531

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has given rise to an increasing number of neurological complications that cause high morbidity and mortality. Our previous studies have characterized central nervous system complications (Ann Hematol, 2018), although the relatively rare peripheral neuropathies remain poorly understood. Apart from those with clear etiologies, such as treatment toxicity and tumor infiltration, a small subset of posttransplant neuropathies known as immune-mediated neuropathies (IMNs) is solely relevant to immune factors. Recently, new insights have been proposed for posttransplant IMNs; for instance, diseases such as radiculoplexus neuropathies and multiple mononeuropathies can also be IMN subtypes, which previously included only Guillain–Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) (J Neurol Neurosurg Psychiatry, 2014). However, the IMNs complicating haplo-HSCT have not been systematically elucidated at present.

Aims

To investigate the incidence, clinical features, risk factors and outcomes of IMNs complicating haplo-HSCT.

Methods

A nested, case-control study was performed based on 3858 patients who received haplo-HSCT at Peking University People’s Hospital. Transplantation was conducted according to our previous protocols. Cases were defined as patients who developed IMNs after haplo-HSCT, which were identified by chart review of clinical manifestations, laboratory findings, electrodiagnostic studies, and radiological findings. Individual matching was performed by randomly selecting 3 controls for each identified case from the same cohort considering the time of HSCT (± 90 days), gender, and follow-up time (± 180 days). 

Results

Forty cases of IMNs were identified from 3858 haplo-HSCT patients, for an incidence rate of 1.04%. The median onset time of the IMNs was 78 days after haplo-HSCT. The identified IMN cases included 10 GBS and 30 peripheral neuropathies that did not meet the diagnostic criteria for GBS or CIDP. The main clinical manifestations were weakness (57.5%), altered sensation (57.5%), hyporeflexia (25%) and pain (10.0%). In the univariate analysis, aGVHD (P=0.116), cGVHD (P=0.024), and CMV viremia (P=0.024) were identified as potential risk factors (P<0.20) for IMNs. However, only CMV viremia (HR=4.557, P=0.024) was identified as an independent risk factor after multivariate analysis. No significant differences in OS (P=0.619), DFS (P=0.609), NRM (P=0.87) or the incidence of relapse (P=0.583) were found between posttransplant patients with and without IMNs. Eleven (27.5%) of the IMN patients developed cGVHD, which was a significantly higher incidence than that of the patients without IMNs (P=0.012). All IMN patients received vitamin B1 and B12 therapy once a diagnosis of IMNs was suspected, and 6 of them achieved neurological improvement without further treatment. IVIG/steroids were given to 25 IMN patients, of whom 18 (72%) subsequently achieved clinical improvement. 

Conclusion

CMV viremia is the only independent risk factor for rare posttransplant IMNs. Haplo-HSCT patients with IMNs are at a higher risk of developing cGVHD. Vitamin B and IVIG/steroids can help improve neurological outcomes. In the future, prospective multicenter studies are needed to increase our understanding of the underlying pathogenesis and to propose standardized diagnostic and therapeutic strategies.

Session topic: 22. Stem cell transplantation - Clinical

Keyword(s): Complications, Cytomegalovirus, Graft-versus-host disease (GVHD), Haploidentical stem cell transplantation

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