Effect of Early Hematopoietic Stem Cell Transplantation on Carpal Tunnel Syndrome Surgery in Patients With Hurler Syndrome.

PURPOSE: The purpose of this study was to investigate whether early hematopoietic stem cell transplantation (HSCT) in infants with Hurler syndrome affects the timing of carpal tunnel syndrome (CTS) surgery.

METHODS

Forty-seven patients with Hurler syndrome who underwent allogeneic HSCT at the University of Minnesota between 2005 and 2020 at early (3-13 months), middle (13-18 months), and late (18-35 months) age tertiles were followed for at least 4 years to determine (1) the timing of CTS diagnosis based on electrodiagnostic testing and (2) the timing of surgical intervention for CTS. A cumulative incidence function was used to estimate the time to surgery.

RESULTS

Based on electrodiagnostic testing, the risk of CTS diagnosis after HSCT increased as age at HSCT increased from 3 to 15 months old. Surgery was also performed later in patients who were transplanted at younger ages, occurring at a median of 7.3 years after HSCT for the early tertile of transplant ages versus 3.5 years after HSCT for the middle and late tertiles of transplant ages.

CONCLUSIONS

Early HSCT in patients with Hurler syndrome may delay the need for CTS surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.