Treatment of paraneoplastic neurological syndromes with antineuronal antibodies (Anti-Hu, Anti-Yo) with a combination of immunoglobulins, cyclophosphamide, and methylprednisolone
- aDepartment of Neurology, Hôpital de la Salpêtrière, Paris, France, bUnité INSERM 495, Hôpital de la Salpêtrière, Paris, France, cService of Neurology CS “Principes Espana” Hospitalet del Llobregat, Spain, dService of Neurology, Hospital Clinic i provincial, Barcelona, Spain, eService of Neurology B and Inserm U 433, Hôpital Neurologique, Lyon, France, fUnité INSERM 472. Hôpital P, Brousse, Villejuif Cedex, France
- Dr Jean-Yves Delattre, Service de Neurologie, Hôpital de la Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
- Received 22 March 1999
- Revised 25 August 1999
- Accepted 3 September 1999
Abstract
OBJECTIVES To evaluate the effect of a combination of immunoglobulins (IVIg), cyclophosphamide (CTX), and methylprednisolone (MP) on the clinical course of patients with paraneoplastic neurological syndrome (PNS) and antineuronal antibodies (Abs).
METHODS Seventeen patients with paraneoplastic encephalomyelitis/sensory neuropathy (PEM/SN) with anti-Hu Abs (n=10) or cerebellar degeneration (PCD) with anti-Yo Abs (n=7) received one to nine cycles (mean 3.5) of a combination of IVIg (0.5 g/kg/day from days 1 to 5), CTX (600 mg/m2 at day 1) and MP (1g/day from day 1 to 3). The Rankin scale (RS) was used to evaluate the response. A positive response was considered as either improvement or stabilisation in patients who were still ambulatory (RS≤3) at the onset of treatment, whereas only improvement, and not stabilisation, was considered a therapeutic benefit in bedridden patients (RS≥4).
RESULTS Tolerance was good and no patient experienced grade 3/4 toxicity (World Health Organisation). Sixteen patients were evaluable for response. Of the seven patients with RS≥4, none improved. Of the nine patients with RS≤3, none improved but three (two SN and one PCD) stabilised for 4, 35, and 16 months.
CONCLUSIONS This study suggests that vigorous immunosuppressive treatment is not useful in severely disabled PNS patients with antineuronal Abs. In a minority of patients (mainly with SN) who are not severely disabled at the onset of treatment, a transient stabilisation is possible and deserves further evaluation.
