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High prevalence of small- and large-fiber neuropathy in a prospective cohort of patients with moderate to severe chronic GvHD

Bone Marrow Transplantation volume 51, pages 1513–1517 (2016)Cite this article

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Increasing safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT) has also increased the number of patients at risk for developing chronic GvHD (cGvHD). Peripheral nerve neurological manifestations and symptoms are being increasingly recognized in cGvHD, however, prospectively planned clinical studies have rarely been reported. There is a substantial lack of understanding of the mechanisms that lead to peripheral neuropathy (PN) in cGvHD and therapeutic options are profoundly limited and mostly symptomatic. Currently, myasthenia gravis, muscle cramps and PN are considered as ‘other’ complications related to cGvHD, whereas myositis and polymyositis are considered as ‘distinctive’ neurological manifestations of cGvHD. Consequently, the diagnosis of neurological cGvHD can only be established when additional ‘diagnostic’ manifestations of cGvHD are present and the neurological manifestations are still not incorporated into the scoring system.1, 2 This presents an important gap, because damage of the peripheral nervous system (PNS) in the context of cGvHD can produce severe disability, morbidity and mortality.2

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Acknowledgements

Statistical analyses were performed by Assist Professor Milan Milosevic MD PhD, University of Zagreb School of Medicine. We show our gratitude to Dina Ljubas, Ljubica Rajic, Nadira Durakovic, Zinaida Peric, Davorka Dusek, Ines Bojanic, Magdalena Grce, Drago Batinic, Renata Zadro, Igor Petricek, Tamara Vukic, Ema Prenc and Iva Ozana Prah for their valuable work and collaboration in this multidisciplinary team. The opinions expressed here are those of the authors and do not represent the official position of the NIH or the US Government. All patients or their parents (for paediatric patients) signed informed consent approved by ethical committees of the University Hospital Centre and Medical School University of Zagreb, Zagreb, Croatia. This work is funded by the Unity Through Knowledge Fund project entitled ‘Clinical and biological factors determining severity and activity of chronic GvHD after allogeneic hematopoietic stem cell transplantation’. In part support is also provided by the Center for Cancer Reserach, the intramural program of the National Cancer Institute, National Institutes of Health, USA.

Author contributions

Ervina B, SZP, RV, LD and DN contributed to the conception and design of the work. Ervina B, VD, LD, DP, MMS, RC, TKP, Ernest B, MB, RSS, IA, OM and RV contributed to acquisition and analysis of the data. Ervina B, VD, LD, DP, Ernest B, MB, LMC, MMS, RC, TKP, IA, RV, DN and SZP contributed to interpretation of the data. The manuscript was drafted by Ervina B, VD, Ernest B, DP and LMC. All authors revised the work critically for important intellectual content, approved final version of the manuscript and agreed to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia

    E Bilic, V Delimar & O Milos

  2. University of Zagreb School of Medicine, Zagreb, Croatia

    E Bilic, D Pulanic, E Bilic, R Ceovic, R Vrhovac & D Nemet

  3. Division of Haematology, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia

    L Desnica, D Pulanic, R S Seiwerth, R Vrhovac & D Nemet

  4. Faculty of Medicine Osijek, JJ Strossmayer University of Osijek, Osijek, Croatia

    D Pulanic, I Aleric & D Nemet

  5. Department of Pediatric Haematology and Oncology, University Hospital Centre Zagreb, Zagreb, Croatia

    E Bilic

  6. Institute of Forensic Medicine and Criminalistics, University of Zagreb School of Medicine, Zagreb, Croatia

    M Bakovic

  7. Experimental Transplantation & Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    L M Curtis & S Z Pavletic

  8. University of Zagreb, School of Dental Medicine, Zagreb, Croatia

    M M Stipetic

  9. Clinical Department of Oral Medicine, University Dental Clinic, University Hospital Centre Zagreb, Zagreb, Croatia

    M M Stipetic

  10. Department of Dermatology and Venerology, University Hospital Centre Zagreb, Zagreb, Croatia

    R Ceovic

  11. Gynecology Department, Community Health Center Zagreb East, Zagreb, Croatia

    T K Pulanic

  12. Department of Pulmology, University Hospital Centre Zagreb, Zagreb, Croatia

    I Aleric

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  1. E Bilic
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Correspondence to E Bilic.

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Bilic, E., Delimar, V., Desnica, L. et al. High prevalence of small- and large-fiber neuropathy in a prospective cohort of patients with moderate to severe chronic GvHD. Bone Marrow Transplant 51, 1513–1517 (2016). https://doi.org/10.1038/bmt.2016.158

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