Clinical effects of cyclophosphamide in Guillain-Barré polyneuritis

(1) Fifteen patients with severe Guillain-Barré polyneuritis in progression were treated with cyclophosphamide in a total of 23 courses. The illnesses in 11 patients were monophasic, 2 were biphasic and 1 was of the chronic, relapsing variety; another was possibly biphasic. Length of illness prior to first course of cyclophosphamide was as follows: less than 1 week, 3; 1-4 weeks, 9; greater than 4 weeks, 3. (2) Progression stopped in association with 21 courses of treatment, in 6 before the treatment course was finished and in 15 an average of 3 days after the last dose. Improvement began during or following 19 courses. (3) Time when progression stopped, time from end of progression to beginning of improvement, and subsequent rate of recovery, suggest that cyclophosphamide made a significant contribution to the recovery processes in 13 patients. (4) Ultimate degree of recovery was not significantly different from that expected in conventionally treated patients with monophasic illnesses. (5) Reversible alopoecia was the only significant complication attributable to cyclophosphamide toxicity. (6) Our experience suggests that further evaluation of cyclophosphamide should include the use of controls and earlier treatment.