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NEUROLOGY 1986;36:1087
© 1986 American Academy of Neurology

Myasthenia gravis after allogeneic bone marrow transplantation

Relationship to chronic graft-versus- host disease

Graeme B. Bolger, Keith M. Sullivan, Alexander M. Spence, Frederick R. Appelbaum, Robert Johnston, Jean E. Sanders, H. Joachim Deeg, Robert P. Witherspoon, Kristine C. Doney, Janet Nims, E. Donnall Thomas and Rainer Storb

Departments of Medicine and Neurology (Drs. Bolger, Sullivan, Spence, Appelbaum, Sanders, Deeg, Witherspoon, Doney, Thomas, and Storb), University of Washington School of Medicine and the Fred Hutchinson Cancer Research Center, Seattle, WA; and the West Side Clinic (Dr. Johnston), Green Bay, WI.

Three patients with chronic graft-versus-host disease (GVHD) developed myasthenia gravis (MG) 762 to 1,180 days after allogeneic bone marrow transplantation. Symptoms of MG were observed after taper or discontinuation of immunosuppressive treatment of chronic GVHD. All patients developed antibodies to acetylcholine receptor, and one had antibody formation to striated muscle. One patient died of complications of treatment of MG. The severity of disease underscores the importance of the differential diagnosis and the need for prompt therapy of this late complication after human bone marrow transplantation.

Address correspondence and reprint requests to Dr. Sullivan, Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104.

Supported by PHS Grant Numbers CA 18221, CA 18029, and CA 15704 awarded by the National Cancer Institute, and HL 36444 (formerly CA 30924) National Heart, Lung and Blood Institute, DHHS. Dr. Thomas is a recipient of a Research Career Award AI 02425 from the National Institute of Allergy and Infectious Diseases.

Accepted for publication November 21, 1985.






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