Analyzing the association between cancer and neuromyelitis optica: a case series

Address for correspondence: Marco A. Lana Peixoto (email: [e-mail]).

Abstract

Background: Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated disorders of the central nervous system, with anti-aquaporin 4 antibodies most often detected in serum. The increasing number of reports associating cancer and NMOSD raises questions about their interconnectedness, especially when considering a cross-reactive mechanism of tumor cells triggering autoimmunity.

Objective: To investigate the prevalence and characteristics of patients with both cancer and NMOSD, to gain insights into those under care at the CIEM MS Research Center.

Methods: We reviewed the medical records of patients at our center diagnosed with NMOSD with a history of cancer.

Results: In a cohort of 281 patients with NMOSD, 8 met the established criteria (2.8%); 4 (50%) of them tested positive for anti-AQP-4 antibodies, and 6 (75%) were female subjects. The tumors identified included breast and cervical cancers (25% each), multiple myeloma (12.5%), pheochromocytoma (12.5%), prostate cancer (12.5%), and bladder cancer (12.5%). The patients presented heterogeneous phenotypes, with initial symptoms such as myelitis (62.5%), optic neuritis (50%), area postrema syndrome (50%), and brainstem syndrome (12.5%). Longitudinally-extensive transverse myelitis (LETM) was prominent, occurring in 7 (87.5%) patients, whereas optic neuritis occurred in 6 (75%) subjects.

Conclusion: Our findings are in line with those reported in the literature, indicating an association pf 3 to 12% between NMOSD and cancer, predominantly in female patients. The most prevalent symptom was LETM. In agreement with other published series, breast and genitourinary cancers were frequently-reported histological types.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 October 2024