Successful Treatment of anti‑MAG Neuropathy Associated with Monoclonal Gammopathy of Undetermined Significance with Rituximab and Dexamethasone – a Case Report

Česká verzia

Authors: T. Pika ¹; P. Folprechtová ²; L. Roubalová ³ ; P. Lochman ³; V. Ščudla ¹
Authors place of work: Hemato-onkologická klinika LF UP a FN Olomouc ¹; Neurologická ambulance, SPEA Olomouc, s. r. o. ²; Oddělení klinické biochemie, FN Olomouc ³
Published in the journal: Cesk Slov Neurol N 2015; 78/111(4): 474-476
Category: Case Report
doi: https://doi.org/10.14735/amcsnn2015474

Summary

We present a case of a patient with anti-MAG neuropathy associated with monoclonal gammo-pathy of undetermined significance. Complex examination did not reveal another cause of neuropathy. A combination therapy with dexamethasone and rituximab at regular weekly applications for eight weeks was selected. Treatment led to improvement in subjective symptoms and a decrease in serum levels of monoclonal immunoglobulin and anti-MAG antibodies. Objective neurological findings remained unchanged.

Key words:
polyneuropathy – anti-MAG antibodies – monoclonal gammopathy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Kyle RA, Therneau TM, Rajkumar SV, Remstein ED, Offord JR, Larson DR et al. Long‑term follow‑up of IgM monoclonal gammopathy of undetermined significance. Blood 2003; 102(10): 3759– 3764.

2. Kyle RA, Dispenzieri A, Kumar S, Larson D, Therneau T,Rajkumar SV. IgM monoclonal gammopathy of undetermined significance (MGUS) and smoldering Waldenström’s macroglobulinemia (SWM). Clin Lymph Myeloma 2011; 11(1): 74– 76. doi: 10.3816/ CLML.2011.n.011.

3. Luigetti M, Padua L, Mazza S, Rossini PM, Sabatelli M,Lo Monaco M. Clinical‑ neurophysiological correlations in a series of patients with IgM‑related neuropathy. Clin Neurophysiol 2013; 124(9): 1899– 1903. doi: 10.1016/ j.clinph.2013.02.116.

4. Kelly JJ. Peripheral neuropathies associated with monoclonal gammopathies of undetermined significance. Rev Neurol Dis 2008; 5(1): 14– 22.

5. Latov N, Hays A, Sherman WH. Peripheral neuropathy and anti‑MAG antibodies. Crit Rev Neurobiol 1988; 3(4): 301– 332.

6. Bruno A, Shah N, Lin C, Close B, Hess DC, Davis K et al. Improving modified Rankin scale assessment with a simplified questionnaire. Stroke 2010; 41(5): 1048– 1050. doi: 10.1161/ STROKEAHA.109.571562.

7. Dalakas MC. Pathogenesis and treatment of Anti‑MAG neuropathy. Curr Treat Opt Neurol 2010; 12(2): 71– 83. doi: 10.1007/ s11940‑ 010‑ 0065‑ x.

8. Dimopoulos MA, Gertz MA, Kastritis E, Garcia‑ Sanz R, Kimby EK, Leblond V et al. Update on treatment recommendations from the Fourth International Workshop on Waldenstrom`s macroglobulinemia. J Clin Oncol 2009; 27(1): 120– 126. doi: 10.1200/ JCO.2008.17.7865.

9. Levine TD, Pestronk A. IgM antibody‑related polyneuropathies: B‑ cell depletion chemotherapy using rituximab. Neurology 1999; 52(8): 1701– 1704.

10. Hospital MA, Viala K, Dragomir S, Levy V, Cohen‑ Aubart F, Neil J et al. Immunotherapy‑based regimen in anti‑MAG neuropathy: results in 45 patients. Hematologica 2013; 98(12): e155– e157. doi: 10.3324/ haematol.2013.087213.

11. Dalakas MC, Rakocevic G, Salajegheh M, Dambrosia JM,Hahn AE, Raju R et al. Placebo‑ controlled trial of rituximab in IgM anti‑myelin‑associated glycoprotein antibody demyelinating neuropathy. Ann Neurol 2009; 65(3): 286– 293. doi: 10.1002/ ana.21577.

12. Leger JM, Viala K, Nicolas G, Créange A, Vallat JM, Pouget J et al. Placebo‑ controlled trial of rituximab in IgM anti‑myelin‑associated glycoprotein neuropathy. Neurology 2013; 80(24): 2217– 2225. doi: 10.1212/ WNL.0b013e318296e92b.

13. Sala E, Robert‑ Varvat F, Paul S, Camdessanché JP, Antoine JC. Acute neurological worsening after Rituximab treatment in patients with anti‑MAG neuropathy. J Neurol Sci 2014; 345 (1– 2): 224– 227. doi: 10.1016/ j.jns.2014.07.055.