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Neuralgic amyotrophy following high-dose melphalan and autologous peripheral blood stem cell transplantation for AL amyloidosis

Bone Marrow Transplantation volume 53, pages 371–373 (2018)Cite this article

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Neuralgic amyotrophy (also known as Parsonage-Turner syndrome, idiopathic brachial neuritis, or brachial plexopathy) is characterized by severe, sudden-onset upper limb pain followed by weakness within a few hours or days, not responsive to analgesics [1, 2]. The pathogenesis is unknown, but the idiopathic form is believed to be immune-mediated. It is difficult to recognize because often the pain, paresis, and sensory symptoms are not all in the same nerve territory distribution, and so there is an average delay of 3 to 9 months before diagnosis is made [1, 2]. Although the brachial plexus can be affected in a patchy manner, upper and middle trunk distribution is most common. Neuralgic amyotrophy has been mainly described following surgery [3], viral infection, or immunosuppression [4]. A hereditary form also exists associated with a point mutation or duplication of the SEPT9 gene, and is much rarer. It is treated conservatively with analgesics, physical therapy, and occasionally steroids in the acute period [1]. Parrish et al. [5] reported three cases of neuralgic amyotrophy in patients with multiple myeloma following high-dose melphalan and autologous stem cell transplantation (HDM/SCT), but there has never been a reported case after treatment of immunoglobulin light chain (AL) amyloidosis following HDM/SCT.

Here we report two cases of neuralgic amyotrophy following HDM/SCT for AL amyloidosis. These cases were prospectively identified from a population of 42 patients with AL amyloidosis who underwent HDM/SCT at Boston Medical Center between January 2014 and June 2017.

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Acknowledgements

We gratefully acknowledge the numerous colleagues in the Amyloidosis Center, Cancer Clinical Trials Office, and Center for Cancer and Blood Disorders at Boston Medical Center who assisted with the multidisciplinary evaluation and treatment of the patients with AL amyloidosis.

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Authors and Affiliations

  1. Section of Hematology & Medical Oncology, Department of Medicine, Boston Medical Center, Boston, MA, USA

    V. P. Nguyen, D. Brauneis, J. M. Sloan, S. Sarosiek, K. Quillen, A. C. Shelton & V. Sanchorawala

  2. Department of Neurology, Boston Medical Center, Boston, MA, USA

    M. Kaku

  3. Amyloidosis Center, Boston University School of Medicine, Boston, MA, USA

    V. P. Nguyen, D. Brauneis, M. Kaku, J. M. Sloan, S. Sarosiek, K. Quillen, A. C. Shelton & V. Sanchorawala

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  1. V. P. Nguyen
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  2. D. Brauneis
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Correspondence to V. Sanchorawala.

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Nguyen, V.P., Brauneis, D., Kaku, M. et al. Neuralgic amyotrophy following high-dose melphalan and autologous peripheral blood stem cell transplantation for AL amyloidosis. Bone Marrow Transplant 53, 371–373 (2018). https://doi.org/10.1038/s41409-017-0048-6

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