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Peripheral neuropathy after bone marrow transplantation
1Department of Neurology, City of Hope National Medical Center, Duarte, CA 91010-3000, USA.
Summary
Peripheral neuropathy following bone marrow transplant can cause severe motor disability. Identifying immunologically-mediated causes is crucial for timely immunosuppressant therapy adjustments.
Area of Science:
- Neurology
- Immunology
- Hematology
Background:
- Peripheral neuropathy is a significant complication of bone marrow transplantation (BMT).
- Severe neuropathies, often demyelinating, occur early post-transplant and carry high morbidity/mortality.
- The exact immunological mechanisms driving these neuropathies remain unclear.
Purpose of the Study:
- To review the causes and characteristics of peripheral neuropathies post-BMT.
- To highlight the importance of early diagnosis and management of these debilitating conditions.
Main Methods:
- Review of clinical presentations and electrophysiologic/histopathologic findings.
- Analysis of potential causative agents including immunosuppressants, chemotherapy, and critical illness.
- Discussion of diagnostic challenges and therapeutic considerations.
Main Results:
- Severe neuropathies are often demyelinating and potentially immunologically mediated, possibly triggered by agents like cyclosporin, FK-506, and interferon-alpha.
- Pre-existing demyelinating conditions can worsen post-transplant.
- Other causes include high-dose cytosine arabinoside, critical illness polyneuropathy, and certain chemotherapies (etoposide, thalidomide, cisplatin, paclitaxel).
Conclusions:
- Transplant physicians must identify potentially immune-mediated neuropathies using nerve conduction tests.
- Empirical adjustment of immunosuppressant therapy is often necessary.
- Limited experience currently restricts definitive treatment regimens and optimal sequencing of immunosuppressants.