Clinical Analysis of Ataxia as Major Performance in the Dystrophy Neuropathy Cases Following Allogeneic Hematopoietic Stem Cell Transplantation

Objective To analysis the clinical characteristics of dystrophy neuropathy cases after allogeneic hematopoietic stem cell transplantation（HSCT）. Methods The clinical charactaristics, diagnostic and therapeutic process and prognostic follow-up in patients diagnosed of dystrophy neuropathy following HSCT between 1st January 2010 to 31st January 2020 at Department of Hematology, Guangdong Provincial People's Hospital were retrospectively analyzed. A systematic literature review was performed for similar published cases in Wanfang, Weipu,CNKI and PubMed database, using keywords as followed: “Wernicke's encephalopathy （WE）” OR “subacute combined degeneration of spinal cord （SACD）”, AND “allogeneic stem cell transplantation” OR“HSCT”OR “bone marrow transplantation” OR “transplantation”, et al. The retrieval time was up to 31st January 2020. Results Five patients were accounted for about 1% of a11 482 patients who received HSCT at that time. Typical symptom was ataxia,four patients accompany with abnormal cognition, similar with the 20 cases in reviewed literatures, but overlap with graft versus host disease （GVHD） and thrombotic microangiopathy （TMA）, all were diagnosed as WE and were ameliorated after receiving vitamin B1 supplement therapy. One patient with myelopathy accompany with dysuria and numbness of buttocks and perineum was diagnosed as SACD, symptoms and radiological information were similar with the 2 cases confirmed by autopsy in Japan, all with a history of high doses methotrexate, and the prognosis was good for our patient after treatment of leucovorin, ademetionine, aminophylline and vitaminB12. Conclusions Dystrophy neuropathy was an easily overlooked complication after HSCT, which was often accompanied by GVHD and TMA. It lacked laboratory detection methods and had a high mortality rate. However, early intervention after early diagnosis according to clinical symptoms and imaging data was effective. When the patients appear ataxia with abnormal cognition or myelopathy after HSCT, WE or SACD should be awared, and vitamin B1 or leucovorin, vitaminB12 were safe and effective treatment.