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

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.

KEYWORDS:

• Hematopoietic stem cell transplantation
• leukemia
• acute demyelinating myelopathy
• rituximab

Acknowledgments

The authors thank doctor Ying Wang, in the Department of Hematology, the Second Hospital of Hebei Medical University, as well as the patient and his family for their contribution to this report.

Authors’ Contributions

Fuxu Wang and Xuejun Zhang designed the study. Lina Xing and Fuxu Wang were primarily responsible for writing the manuscript. Fuxu Wang, Xuejun Zhang, Shupeng Wen, Zhiyun Niu provided a case for the study. Fuxu Wang revised the manuscript critically. All authors read and approved the final manuscript.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Declaration of Financial/other Relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial relationships to disclose.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Statement of Ethics

This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University (2019-P026). Written informed consent was obtained from the patient and donor for publication of this case report and any accompanying images.

Additional information

Funding

No funding was received for any work presented in this manuscript.