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Ann Hematol. 2018 Aug;97(8):1399-1406. doi: 10.1007/s00277-018-3299-4. Epub 2018 Mar 22.

IgG synthesis rate and anti-myelin oligodendrocyte glycoprotein antibody in CSF may be associated with the onset of CNS demyelination after haplo-HSCT.

Zhang XH1,2,3, Zhao X4,5,6, Wang CC4,5,6, Han W4,5,6, Chen H4,5,6, Chen YH4,5,6, Wang FR4,5,6, Wang JZ4,5,6, Zhang YY4,5,6, Mo XD4,5,6, Chen Y4,5,6, Wang Y4,5,6, Fu HX4,5,6, Chang YJ4,5,6, Xu LP4,5,6, Liu KY4,5,6, Huang XJ7,8,9.

Author information

1
Peking University People's Hospital, Peking University Institute of Hematology, No. 11Xizhimen South Street, Beijing, Xicheng District, China. zhangxh100@sina.com.
2
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China. zhangxh100@sina.com.
3
Collaborative Innovation Center of Hematology, Peking University, Beijing, China. zhangxh100@sina.com.
4
Peking University People's Hospital, Peking University Institute of Hematology, No. 11Xizhimen South Street, Beijing, Xicheng District, China.
5
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
6
Collaborative Innovation Center of Hematology, Peking University, Beijing, China.
7
Peking University People's Hospital, Peking University Institute of Hematology, No. 11Xizhimen South Street, Beijing, Xicheng District, China. drhuangxj@163.com.
8
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China. drhuangxj@163.com.
9
Collaborative Innovation Center of Hematology, Peking University, Beijing, China. drhuangxj@163.com.

Abstract

Haploidentical hematopoietic stem cell transplant (haplo-HSCT) is an upfront and effective therapy for hematology patients, but it usually has many complications, such as neurological complications. As one of the neurological complications following haplo-HSCT, immune-mediated demyelinating diseases of the central nervous system (CNS) seriously affect a patient's quality of life. However, the incidence, risk factors, and pathogenesis of CNS demyelination are not very well understood. Thirty of the 1526 patients (1.96%) suffered from CNS demyelination. In univariate analysis, we found that blood-brain barrier (BBB) permeability and the CSF IgG synthesis index (IgG-Syn) were related to the occurrence of CNS demyelination (p < 0.05). In a multivariate analysis, the IgG-Syn (OR = 1.017, 95% CI 1.003-1.031, p = 0.019) and CSF anti-myelin oligodendrocyte glycoprotein antibody (MOG.Ab) (OR = 12.059, 95% CI 1.141-127.458, p = 0.038) were independently associated with the onset of CNS demyelination. We also studied the possible pathogenesis of CNS demyelination. Immune reconstitution (the cell proportions of CD19+ B cells, CD3+ T cells, and CD4+ T cells); the counts of leucocytes, lymphocytes, monocytes, and platelets; and the levels of immunoglobulins A, G, and M 30, 60, and 90 days after HSCT showed no significant differences between CNS demyelination and no demyelination (p > 0.05). The probabilities of overall survival showed no significant differences between patients with and without demyelination (p > 0.05). Only four deaths in 30 patients, but bringing projected survival to less than 20%.We imply that IgG-Syn and CSF MOG. Ab may be associated with the onset of CNS demyelination during 2 weeks of neurological symptoms in patients with brain or spinal cord MRI abnormality. Immune reconstitution may not be the pathogenesis of CNS demyelination.

KEYWORDS:

Antibody; CNS demyelination; Haploidentical stem cell transplantation

PMID:
29568992
DOI:
10.1007/s00277-018-3299-4
[Indexed for MEDLINE]

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