Guillain-Barre Syndrome Associated with Rapid Immune Reconstitution Following a Tandem Autologous Hematopoietic Stem Cell Transplantation. Study of a Case and Review of the Literature

L Guilloton ,C Faulcon ,Nicolas Virelizier E ,Wey Pf ,F Petitjean ,Hervé Ghesquières ,Aurélie Drouet ,Pierre Biron

doi:10.4172/2165-7920.1000508

Abstract

Introduction: Guillain-Barre syndrome (GBS) is a frequent cause of neuromuscular paralysis and usually occurs after an immunoallergic reaction, most often after respiratory or gastrointestinal infection. However, rare cases of Guillain-Barre syndrome are described, associated with hematopoietic stem cell transplantation. Observation: Patient n° 20452690. The authors report the case of 21 years old man, treated for Hodgkin lymphoma with a recurrence at 18 months, who enjoyed second autologous hematopoietic stem cell transplantation after conditioning chemotherapy, then developed a Guillain-Barre syndrome. Plasma exchanges were made before a neurological worsening. Thereafter, five cycles of intravenous immunoglobulin were performed monthly. Unfortunately this development was hampered by mechanical respiratory complication that led to the death of the patient, the 237th day of evolution. The final diagnosis of Guillain-Barre syndrome, occurred in a context of post-transplant immune reconstitution in a patient treated for Hodgkin lymphoma was retained. Discussion: GBS is a rare complication of hematopoietic stem cell transplantation. After literature review, we collected 33 cases related to this disease, 10 occurred after autograft. Etiopathogenic mechanisms remain obscure. Despite the use of immunomodulatory treatment, the prognosis is often severe and dark. Conclusion: GBS is possible after autologous hematopoietic stem cell transplantation indicated for the treatment of Hodgkin lymphoma. The initial clinical severity, despite safeguards and use of immunomodulatory therapy, will cause often deleterious and poor outcome. To our knowledge, this well documented observation is the first case indicated for Hodgkin lymphoma.

Highlights

Guillain-Barré syndrome (GBS) is a frequent cause of neuromuscular paralysis and usually occurs after an immunoallergic reaction, most often after respiratory or gastrointestinal infection
GBS is possible after autologous hematopoietic stem cell transplantation indicated for the treatment of Hodgkin lymphoma
The initial clinical severity, despite safeguards and use of immunomodulatory therapy, will cause often deleterious and poor outcome. This well documented observation is the first case indicated for Hodgkin lymphoma

Summary

Discussion

GBS is a polyradiculoneuropathy characterized by rapidly progressive symmetrical ascending motor weakness: muscles associated to long-fibers nerves are firstly impaired, with loss of deep tendon reflexes, with mild motor deficit, but impairing variably autonomic nervous system. GBS is usually associated with antecedent bacterial or viral infections It can occur concomitantly with neoplasms, blood or immune diseases [4]. GBS has previously been reported in the setting of GCSH, with isolated cases reports; multiple cases reviews are rare [1,5,6,7,8,9] It occurs with a frequency of 0.3%-0.7%, more often in case of allogeneic transplantation. Thone et al [12] described a new case that we did not take into account considering the very long interval between GBS and allogeneic transplantation (more than 10 years); the discussion was mainly focused on host-versus-graft reaction [12]. We report the first case occurring after autologous graft for Hodgkin’s lymphoma

Conclusion

Introduction