In September 2018, findings from reported cases in graft-versus-host-disease (GvHD) associated polymyositis (PM) were published in Clinical Case reports. The authors aimed to review data from two reports of polymyositis-related GvHD in order to better understand this rare complication of allogeneic hematopoietic stem cell transplantations (allo-HSCT).
Case 1
- 48-year-old woman with acute myeloid leukemia (AML), diagnosis in 2013
- Complete remission (CR) after two courses of chemotherapy
- The patient underwent allo-HSCT in February 2014 after reduced intensity conditioning
- New symptoms after 10 months: limb weakness and mild dyspnea after walking without myalgia, skin rash, or obvious dysphagia
Case 2
- 31-year-old woman with AML, diagnosis 20 months ago
- CR was achieved with two courses of chemotherapy
- Allo-HSCT after fifteen months after reduced intensity conditioning
- Hospitalization because of limb weakness and myalgia for 5 months
Test results for Patients 1 and 2 (data is given as Patient 1 and 2)
- CK (U/L): 2118 vs18
- Lactate dehydrogenase (U/L): 528 vs241
- Aspartate aminotransferase (U/L): 89 vs192
- Alanine aminotransferase (U/L): 85 vs137
- Myoglobin (ng/mL): 1057.90 vs3
- CRP (mg/L): 0.2 vs6
- Antinuclear antibodies: 1:100 vs1:320
- Myositis autoantibody: negative in both patients
- Thyroid glands: negative in both patients
Therapy
- Patient 1
- increased dosage of prednisone and cyclosporin A (CsA), but no significant result was seen
- rituximab (100 mg) plus a low dose of intravenous immunoglobulin (IVIG, 5-10 g) weekly was applied for consecutive 6 weeks
- the patient’s CK level became normal
- Patient 2
- oral prednisone and CsA did not improve the patient’s status
- tacrolimus (3 mg QD) combined with oral methylprednisolone (40 mg QD) was implemented
- Patient 2 had been followed up for over 1 year and she is in a good condition receiving tacrolimus at 3 mg with methylprednisolone at 12 mg daily
In summary, these case reports show that patients who underwent allo-HSCT can develop T cell-mediated immunologic muscle disorder which is similar to polymyositis with comparable clinical manifestations. Corticosteroids and immunosuppressants are feasible therapy options.