Rituximab for polyneuropathy with IgM monoclonal gammopathy.

Abstract

BACKGROUND:

Polyneuropathy with IgM monoclonal gammopathy can be a disabling disorder necessitating treatment.

METHODS:

In a prospective open label trial, 17 patients with disabling IgM MGUS polyneuropathy were treated with rituximab, a chimeric anti-CD-20 monoclonal antibody.

RESULTS:

Rituximab induced an improvement of >or=1 point on the Overall Disability Sum Score in 2/17 patients, an improvement of >or=5% of the distal MRC sum score in 4/17 and the sensory sum score in 9/17 patients. Bone marrow investigations showed CD 20 B cell depletion in all patients. There were no serious adverse events. Compared with treatment with intermittent cyclophosphamide with prednisone or treatment with fludarabine, it shows a comparable response percentages but fewer side effects. The presence of anti-MAG and a disease duration shorter than 10 years may predict treatment response.

CONCLUSION:

Rituximab is a candidate for treatment of IgM MGUS polyneuropathy and should be further investigated in a double-blind randomised trial.

• Authors: J M F Niermeijer, M Eurelings, H L Lokhorst, W-L van der Pol, H Franssen, J H J Wokke, N C Notermans
• Journal: Journal of neurology, neurosurgery, and psychiatry (J Neurol Neurosurg Psychiatry) Vol. 80 Issue 9 Pg. 1036-9 (Sep 2009) ISSN: 1468-330X [Electronic] England
• PMID: 19684235 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Antigens, CD20
• Immunoglobulin M
• Immunologic Factors
• Immunosuppressive Agents
• Rituximab
• Cyclophosphamide
• Vidarabine
• fludarabine
• Prednisone

Topics

• Age of Onset
• Anti-Inflammatory Agents (therapeutic use)
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• Antigens, CD20 (metabolism)
• B-Lymphocytes (immunology)
• Bone Marrow Cells (physiology)
• Cyclophosphamide (therapeutic use)
• Disability Evaluation
• Female
• Humans
• Immunoglobulin M (immunology)
• Immunologic Factors (adverse effects, therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Lymphocyte Count
• Male
• Middle Aged
• Muscle Strength (physiology)
• Neural Conduction (physiology)
• Paraproteinemias (drug therapy, immunology)
• Prednisone (therapeutic use)
• Prospective Studies
• Rituximab
• Sensation (physiology)
• Treatment Outcome
• Vidarabine (analogs & derivatives, therapeutic use)