Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2021; 9(6): 1359-1366
Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1359
Noninvasive tools based on immune biomarkers for the diagnosis of central nervous system graft-vs-host disease: Two case reports and a review of the literature
Hai-Rong Lyu, Xiao-Yuan He, Hong-Jun Hao, Wen-Yi Lu, Xin Jin, Yu-Jiao Zhao, Ming-Feng Zhao
Hai-Rong Lyu, Xiao-Yuan He, Wen-Yi Lu, Ming-Feng Zhao, Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Hong-Jun Hao, Department of Neurology, Peking University First Hospital, Beijing 100034, China
Xin Jin, School of Medicine, Nankai University, Tianjin 300071, China
Yu-Jiao Zhao, Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Author contributions: Lyu HR and Zhao MF contributed equally to this work; Lyu HR and He XY wrote the manuscript; Lyu HR, He XY, Hao HJ and Zhao YJ performed the experiments and analyzed the data; Lu WY and Jin X followed up on the patients; all authors have read and approved the final manuscript.
Supported by National Natural Sciences Foundation of China, No. 81970180 and 81800105; Natural Science Foundation of Tianjin Municipal Science and Technology Commission, China, No. 17JCZDJC35800; and Tianjin Health and Family Planning Commission, China, No. 16KG110.
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Feng Zhao, DPhil, PhD, Chief Doctor, Chief Physician, Department of Hematology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. mingfengzhao@sina.com
Received: September 12, 2020
Peer-review started: September 12, 2020
First decision: November 29, 2020
Revised: December 9, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: February 26, 2021
Processing time: 140 Days and 20.8 Hours
Abstract
BACKGROUND

Central nervous system graft-vs-host disease (CNS-GVHD) is a rare cause of CNS disorders after allogeneic hematopoietic stem cell transplantation. Currently, establishing a diagnosis of CNS-GVHD is challenging because the diagnostic criteria and diagnostic methods are not well defined and many confounding factors need to be ruled out.

CASE SUMMARY

Here, we present two patients with CNS-GVHD. Both patients with a history of acute GVHD or chronic GVHD developed neurological symptoms that could not be explained by other causes, and had abnormal cerebrospinal fluid (CSF) studies as determined by CSF and blood immune biomarker examinations, suggestive of suspected CNS-GVHD. Due to the lack of specific magnetic resonance imaging abnormalities and the rapid clinical deterioration of the patients, we did not attempt to perform a brain biopsy, but prompted the initiation of empirical immunosuppressive therapy. In view of the rapid and favorable response to local and systematic immunosuppressive treatment and the aforementioned neurologic manifestations together with CSF abnormalities and other negative findings, a final diagnosis of CNS-GVHD was made.

CONCLUSION

CSF and blood immune biomarker examinations facilitated the diagnosis of CNS-GVHD, which are particularly suitable for patients who are critically ill and require urgent treatment and for those who are unsuitable for invasive diagnostic procedures.

Keywords: Biomarkers; Immunology; Hematopoietic stem cell transplantation; Graft vs host disease; Central nervous system; Diagnosis; Case report

Core Tip: We systematically report the diagnostic methods used for central nervous system graft-vs-host disease and present our own diagnostic criteria. Furthermore, we propose that non-invasive tools, especially cerebrospinal fluid and blood immune biomarker examinations, facilitated the diagnosis of central nervous system graft-vs-host disease, which are particularly suitable for patients who are critically ill and require urgent treatment and for those who are unsuitable for invasive diagnostic procedures.