Polyneuropathy in the context of acute myeloid leukemia and myelodysplastic disorders.

Abstract

e18008 Background: Polyradiculoneuropathy is not uncommon in the context of the treatment and complication seen in Acute Myeloid Leukemia AML and Myelodysplastic Disorders MDS. Immune mechanism rather than inflammatory demyelinating process is the most likely driving mechanism. This abstract describe our experience with six patients who developed polyradiculoneuropathy in the context of AML and MDS. Methods: This involve six patients who developed polyradiculoneuropathy in the context of treatment with AML and MDS. Mean age is forty two years old ( Range 28-59). Non of the patients had Diabetes mellitus or neuropathy at diagnosis. All patients were induced with high dose Cytosine Arabinoside ARA-C and Anthracyclines. All patients had no evidence of of CNS leukemic involvement or Progressive Multifocal Focal Leukoencephalopathy PML. Compound muscle action potential , Nerve conduction testing , CSF analysis and MRI of Brain and Spinal axis was done on most of the patients. Results: Mean age of of patients is 42. None of the patients had DM or neuropathy at diagnosis.Two males and four females. Three whites , two Hispanics and one Indian. Five patients with De novo AML and one patient with MDS with excess blasts more than 18 %. Two females developed debilitating neuropathy with skin rash and sclerodermoid changes. Two males developed foot drop. One patient developed Parkinson disease with debilitating motor and sensory neuropathy. One female developed transient motor neuropathy that resolved. All patients had no evidence of CNS leukemic involvement as per CSF and MRI testing.Sever attenuation of compound muscles action potential in lower limbs and slowing of nerve conduction in the intermediate nerve sigment were seen. Day Fourteen bone marrow biopsy post induction in all these cases showed absence of blasts with presence of sheets of plasma cells with stromal cells. Two patients are still alive. All four patients died with median duration of 18 months from diagnosis. Conclusions: The importance of microenvironment and plasma cell interaction could be the basis of the pathogenesis of polyradiculoneuropathy. POEMS Syndrome in those cases should be investigated,especially in the lack of gammopathy data and immunostaining.