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Chronic inflammatory demyelinating polyneuropathy in adult T-cell leukemia-lymphoma patients following allogeneic stem cell transplantation

Bone Marrow Transplantation volume 53, pages 1470–1473 (2018)Cite this article

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Adult T-cell leukemia-lymphoma (ATL) is a T-cell malignancy caused by human T-cell leukemia virus type 1 (HTLV-1) [1, 2]. ATL is classified into four clinical subtypes proposed by the Japan Clinical Oncology Group: smoldering, chronic, lymphoma, and acute [1]. Acute- and lymphoma-type ATL have a poor prognosis. Allogeneic hematopoietic stem cell transplantation (allo-SCT) is being increasingly used as a curative therapy for ATL, and confers long-term survival in approximately 40% of ATL patients [2]. One of the major problems of allo-SCT is occurrence of severe complications. We observed ATL patients who developed peripheral neuropathy (PN) following allo-SCT. In this study, we analyzed their disease profiles and investigated the pathophysiology of PN.

We investigated the clinical features of 46 ATL patients who underwent allo-SCT after induction chemotherapy. The study consisted of 25 men and 21 women aged 28–71 (median age: 59) years. The ATL clinical subtypes observed in these patients included 33 (72%), 8 (17%), and 5 (11%) with the acute-, lymphoma-, and unfavorable chronic-types, respectively. Conditioning regimens consisting of myeloablative conditioning (MAC) and reduced intensity conditioning (RIC) were administered to 5 (11%) and 41 (89%) of the patients, respectively. Stem cell sources included the bone marrow for 35 (77%) of the cases, peripheral blood in 10 (21%), and cord blood in 1 (2%). PN was diagnosed by the symptoms of paresthesia, hyperesthesia, abnormal sensations, and muscle weakness. This included damage to sensory and motor nerves with axonal and/or demyelinating damage. We performed a full neurological examination, a nerve conduction study (motor or sensory conduction), as well as radiological procedures such as computed tomography and/or magnetic resonance imaging (MRI). We also performed cell counts, evaluated cerebrospinal fluid (CSF) biochemistry, and measured total protein levels, anti-HTLV-1 antibody titers, neopterin, and CXCL10 levels in CSF.

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Acknowledgements

We would like to express our gratitude to Dr. Eiji Matsuura of the Department of Neurology and Geriatrics, Kagoshima University, for giving advice on writing this paper.

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Authors and Affiliations

  1. Department of Hematology/Oncology, Research Hospital, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Mitsuhito Hirano, Koji Jimbo, Miho Ogawa, Kiyosumi Ochi, Junya Makiyama, Toyotaka Kawamata, Kazuaki Yokoyama, Yoichi Imai & Arinobu Tojo

  2. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takashi Tanaka, Yoshihiro Inamoto & Takahiro Fukuda

  3. Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University Graduate School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki City, Kanagawa, 216-8512, Japan

    Yoshihisa Yamano

  4. Laboratory of Tumor Cell Biology, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan

    Kaoru Uchimaru

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  1. Mitsuhito Hirano
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Correspondence to Yoichi Imai.

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Hirano, M., Jimbo, K., Ogawa, M. et al. Chronic inflammatory demyelinating polyneuropathy in adult T-cell leukemia-lymphoma patients following allogeneic stem cell transplantation. Bone Marrow Transplant 53, 1470–1473 (2018). https://doi.org/10.1038/s41409-018-0202-9

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  • DOI: https://doi.org/10.1038/s41409-018-0202-9

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