Rituximab for acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation: a case report

Postgraduate Medicine
Lina XingXuejun Zhang

Abstract

Acute demyelinating myelopathy after allogeneic hematopoietic stem cell transplantation (HSCT) is rare, and the exact pathogenesis remains unclear. Here, we report the case of a 20-year-old patient with B-cell acute lymphocyte leukemia (B-ALL) who developed acute demyelinating myelopathy approximately 10 months after HSCT. Magnetic resonance imaging revealed high T2 signal intensity lesions from the C2-T4 levels of the spinal cord. Treatments with high doses of corticosteroids, immunoglobulins, and rituximab improved his neurologic symptoms, and he achieved 44 months of leukemia-free and graft-versus-host disease (GVHD)-free survival, with no recurrence of the demyelination myelopathy. An understanding of the contribution of immune reconstitution to the pathogenesis of demyelinating myelopathy after HSCT and the association of this disease with GVHD will require more clinical cases.

References

Oct 24, 2007·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Deborah SiegalVikas Gupta
Feb 15, 2008·The New England Journal of Medicine·Stephen L HauserUNKNOWN HERMES Trial Group
Oct 14, 2009·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Pere BarbaJorge Sierra
Mar 10, 2011·Annals of Neurology·Chris H PolmanJerry S Wolinsky
Mar 2, 2012·Current Neuropharmacology·Ingrid Loma, Rock Heyman
Mar 10, 2016·Proceedings of the National Academy of Sciences of the United States of America·Anne-Christine FlachAlexander Flügel
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Apr 2, 2018·Handbook of Clinical Neurology·Lauren BowenBryan Smith

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