Guillain-Barre syndrome following 2-chlorodeoxyadenosine treatment for hairy cell leukemia

A 68-year-old man, with Hairy Cell Leukemia developed a Guillain-Barre syndrome (G-B), 32 days after a single course of 2-Chlorodeoxyadenosine (CDA) at 0.14 mg/k/d, for five days in a two-hour-i.v. infusion and following a febrile neutropenia episode. In order to clarify whether this G-B case was related to an infection or to CDA neurotoxicity, we screened for infection-related autoimmune G-B and for antibodies (abs.) against gangliosides of peripheral nerves. Blood and urinary cultures were negative as well as serum anti-virus abs. However. serum anti-ganglioside ads. were positive for anti-asialo GM1 and anti-Gd1b. This latter finding was consistent with an autoimmune mechanism, not described until now as CDA neurotoxicity. In the present case, we do not have enough evidence to link CDA administration to the G-B syndrome. We think that it is necessary to exclude other causes of neurotoxicity before considering CDA adverse effect.