Refractory CIDP successfully treated with autologous haematopoietic stem cell transplantation in a patient with monoclonal gammopathy of undetermined significance (MGUS) and rheumatoid arthritis

Neuromuscul Disord. 2022 Jan;32(1):71-74. doi: 10.1016/j.nmd.2021.11.008. Epub 2021 Nov 19.

Abstract

Autologous haematopoietic stem cell transplantation is an emerging treatment option in refractory chronic inflammatory demyelinating polyradiculoneuropathy. We describe a case of a 46-year-old male, with history of IgG/lambda monoclonal gammopathy, who was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy at 27 years of age. After an initial 10-year period of corticotherapy response, the patient experienced severe relapses and disease progression, evolving to a refractory state. First-line and escalating treatment could not achieve clinical stabilization, leading to severe disability. Pre-treatment with ibrutinib was initiated and autologous haematopoietic stem cell transplantation was performed without significant complications. Marked clinical improvement was observed in the following months, both subjective and objective. A significant proportion of the patients who respond to the first-line immunosuppressive therapy eventually become treatment-refractory. Autologous haematopoietic stem cell transplantation may be a treatment option, offering long-term remission with an overall acceptable side effect and risk profile.

Keywords: CIDP; Refractory; Stem cell transplantation.

Publication types

  • Case Reports

MeSH terms

  • Arthritis, Rheumatoid / complications*
  • Disease Progression
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Male
  • Middle Aged
  • Monoclonal Gammopathy of Undetermined Significance / complications*
  • Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / therapy*
  • Transplantation Conditioning*
  • Transplantation, Autologous