Guillain Barre Syndrome Following Stem Cell Transplant: A Single Institution Five -Year Retrospective Study (P1.452)

Objective: Do patients with stem cell transplants (SCT) who subsequently develop Guillain Barre Syndrome (GBS) share a common clinical course? Background: The development of GBS after SCT is a rare finding in clinical practice. This relationship has previously been described as isolated reports and in small case series’ with varying proposed mechanisms ranging from peripheral expansion of T Cells following infection with cytomegalovirus to drug toxicities. Given the high frequency of SCT at our institution, we review a five-year period of patients who meet the criteria to analyze their clinical courses for commonalities. Design/Methods: A five-year retrospective review of the electromyography/nerve conduction studies on 1,929 patients at MD Anderson Cancer Center from 2010 to 2015 was conducted for patients with findings consistent with GBS, yielding 34 unique cases. Charts of these patients were further reviewed to determine the patients with history of SCT before development of GBS and the clinical courses of the patients in the resulting subgroup (7 patients) were reviewed in detail for chemotherapy treatments, history of graft-vs-host disease (GVHD) and clinical outcome. Results: Average time from transplant to GBS diagnosis was 509 days with earliest symptoms at 133 days and latest 1207 days. Four of the seven patients with GBS post-transplant had GVHD prior to GBS diagnosis. Of note, there were multiple instances of additional patients who developed GBS while receiving induction chemotherapy just prior to SCT. There was variability in cancer diagnosis, chemotherapy regimens, and recovery of neurological function. Conclusions: Many factors surrounding care prior to and following a SCT can be potential etiologies for development of GBS, including induction chemotherapy, GVHD, immunosuppression. When close attention is paid to the initial signs of GBS in this patient population, treatment can be started early and clinical outcome optimized. Disclosure: Dr. Metrus has nothing to disclose. Dr. Woodman has nothing to disclose. Dr. Gatson has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novocure (Optune). Dr. Pillainayagam has nothing to disclose.