Serendipitous Improvement of Schizophrenia after Stem Cell Transplant for Hodgkin�s Lymphoma

Case Report

J Schizophr Res. 2018; 5(1): 1036.

Serendipitous Improvement of Schizophrenia after Stem Cell Transplant for Hodgkin’s Lymphoma

González-Llano O¹, Saucedo-Uribe E², Martínez- Garza DM¹, Mancías-Guerra C³, Cantú-Rodríguez OG¹ and Mancías-Guerra MC¹*

¹Hematology Service, Autonomous University of Nuevo León, Mexico

²Department of Psychiatry, Autonomous University of Nuevo León, México

³CIT Neuropsique, México

*Corresponding author: Mancías-Guerra MC, Hematology Service, University Hospital “José E. González”. School of Medicine, Autonomous University of Nuevo León, Monterrey, México

Received: September 06, 2018; Accepted: November 01, 2018; Published: November 08, 2018


21-year-old male patient with schizophrenia diagnosed at age 15 with a history of poor response to olanzapine and risperidone. He referred auditory hallucinations with a pejorative content about himself. He was very suspicious and socially with drawn, to the extent of dropping out of high school and being unable to leave his home. One year afterward he was diagnosed with Hodgkin’s Lymphoma (HL). He underwent different chemotherapeutic schemes and three Stem Cell Transplants (SCT). Between the second and the third SCT, the patient received therapeutic doses of quetiapine (Positive and Negative Syndrome Scale [PANSS]: 147). In a period of 8 months, after the second SCT, patient’s PANSS dropped 60 points, his hallucinations decreased 90%, and he improved his negative, cognitive, and social symptoms, which allowed him to gradually reincorporate to his usual social and academic life.

Currently, Hematopoietic Stem Cells (HSC) have been proposed as an alternative therapy for many chronic and incurable non-hematologic diseases. In psychiatry, the theory is that these HSC migrate to areas of inflammation in the brain via chemotaxis, and, through immunomodulation and secretion of bioactive molecules enhance neurogenesis, angiogenesis, and remodeling of axonal circuits. Studies on schizophrenic patients have confirmed both, that it is an inflammatory condition (cytokines and interleukins are elevated when compared to controls) and, that the brain is underdeveloped due to deficient neurogenesis; supporting. why HSC assisted in the marked clinical improvement observed in this patient, which would otherwise could not be explained by the natural history of the disease or therapeutic measures alone.

Keywords: Schizophrenia; Stem cell transplant; Hematopoietic stem cells; Neurogenesis; Neuroimmunomodu


Psychiatry has fallen behind other medical specialties regarding treatment innovation [1]. It is so, that most of the first line medications are now over 40 years old, and the last drug with an original mechanism of action was introduced almost a decade ago [2]. Nonetheless, psychiatric disorders have a prevalence that may be as high as 26% [3], urging the need to develop novel and precise therapeutic offers [4]. Schizophrenia, with more than 20 million people affected worldwide, currently the third-most disabling condition [5], a lifetime prevalence of 0.7%, and carrying a great burden of human and economic costs [6], is just one of the many examples of mental health diseases demanding new approaches [7-15].

Since their discovery, stem cells have been used as an alternative treatment for many diseases, especially chronic diseases with not few therapeutic options, such as heart and autoimmune disorders [16]. Mental health is not the exception, as psychiatric conditions may be caused by deficiencies in neurogenesis and neurodevelopment, in which stem cells, hypothetically may be able to restore proper psychological function of areas where cells have died or are dysfunctional, or may enhance some degree of neurogenesis [17,18].

Case Report

The patient is a male that started experiencing outbreaks of psychotic symptoms at the age of 15. The family was skeptic about this, so they did not seek for help until after a year when symptoms became more florid. The diagnosis of schizophrenia was made. Olanzapine 10 mg QD and risperidone 4 mg QD were indicated, without satisfactory results, despite complete adherence. Two years later from the start of symptoms the patient sought for a second opinion, being attended by us.

On examination, he appeared disheveled, suspicious, and very anxious. He was very inexpressive with an indifferent and flat affect, avoided eye contact, and was very uncooperative. He had a disorganized thought process and answered to most questions monosyllabically. Patient referred auditory hallucinations; he heard two voices that made fun of him. He had reference delusions about his neighbors and peers making fun of him and claiming that “he was homosexual”. Hence, he became socially withdrawn and eventually dropped out of high school. He did not abandon his home for anything but therapy. Patient slept all day but could not sleep at night because of fear; he sometimes would hide in the walls of his home because he thought people were spying on him. The diagnosis of schizophrenia with predominant negative symptoms was confirmed (positive and negative syndrome scale [PANSS]: 147). He was started on an in crescendo scheme of quetiapine until he reached a maintenance dose of 300mg bid.

Meanwhile, he was concomitantly diagnosed with HL (Figure 1). He received an induction treatment with an ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) scheme and received an autologous SCT of peripheral blood as consolidation treatment with etoposide and carmustine as conditioning regimen. Six 3 months later, he relapsed and was started on a second-line scheme that included ifosfamide, gemcitabine, and vinorelbine as the induction therapy, this time he was consolidated with a second autologous SCT with peripheral cryopreserved cells with busulfan and melphalan as conditioning regimen. The patient went into a second complete remission, though, he relapsed for the second time. He underwent a rescue scheme using brentuximab and was now submitted to a haploidentical SCT. Cyclophosphamide, fludarabine, and melphalan were used as conditioning. He reached complete remission, is free of HL and without data of graft versus host disease. Over a period of 18 months the patient received a total of 15×106/kg HSC.

Citation: González-Llano O, Saucedo-Uribe E, Martínez-Garza DM, Mancías-Guerra C, Cantú-Rodríguez OG and Mancías-Guerra MC. Serendipitous Improvement of Schizophrenia after Stem Cell Transplant for Hodgkin’s Lymphoma. J Schizophr Res. 2018; 5(1): 1036.