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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 tumor

9.4 cm right paraspinal mass

8 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