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Table 1 Summary of Past Oncologic History & Management of GBS/AIDP

From: Guillain-Barre syndrome observed with adoptive transfer of lymphocytes genetically engineered with an NY-ESO-1 reactive T-cell receptor

 Patient 1
47-year old female
Patient 2
39-year old female
Primary tumor9.4 cm right paraspinal mass8 cm left thigh mass
Prior chemotherapy• Ifosfamide ×4 cycles
• Doxorubicin ×6 cycles
• Treatment break/surveillance
• Pazopanib
• Doxorubicin/ifosfamide × 4 cycles
• Pazopanib
Sites of disease prior to lymphodepletion• Bilateral lungs, spine, right groin• Lung, local thigh recurrence
Lymphodepletion regimen• Fludarabine 20 mg/m2 (dose reduced from 30 mg/m2 due to renal dysfunction per protocol) daily ×4 days
• Cyclophosphamide 1800 mg/m2 daily × 2 days
• Fludarabine 30 mg/m2 daily × 4 days
• Cyclophosphamide 1800 mg/m2 daily × 2 days
Onset of Symptoms of GBS/AIDP• Day 42: 1-week history of numbness, paresthesia, heaviness to both legs; difficulty walking on day 42; pt. declined admission• Month 4 follow-up visit: bilateral foot numbness, left foot drop, unsteady gait, and pain in left thigh
Admission for workup of symptoms• Day 46: admitted for workup; numbness & paresthesias w/hypoesthesia starting with feet & ascending to hips bilaterally• Day 128: admitted for workup; additional worsening neurologic symptoms of peripheral sensory and motor neuropathy
Electromyography / nerve conduction studies• Day 48: very mild, distal motor, axonal polyneuropathy• Non-length dependent demyelinating sensorimotor polyneuropathy
Lumbar Puncture• Day 49: CSF with no pleiocytosis, malignant cells, infectious processes, or albuminocytologic dissociation• CSF with no malignant cells, low cell count, no bacteria, negative viral studies
Intravenous Immuneglobulin (IVIG)• Day 48–52: IVIG 0.4 g/kg/day for 5 days• IVIG 0.4 g/m/day for 5 days
Improvement of Symptoms• Day 50: improvement in symptoms & strength per patient• Improved strength the day after completion of IVIG
Able to Ambulate• Day 60: with walker under supervision• 6-month follow-up visit: strength and sensory neuropathy continued to improve, but still using walker