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Rituximab for polyneuropathy with IgM monoclonal gammopathy
  1. J M F Niermeijer1,
  2. M Eurelings1,
  3. H L Lokhorst2,
  4. W-L van der Pol1,
  5. H Franssen1,
  6. J H J Wokke1,
  7. N C Notermans1
  1. 1
    Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center, Utrecht, The Netherlands
  2. 2
    Department of Haematology, University Medical Center, Utrecht, The Netherlands
  1. Correspondence to Dr J M F Niermeijer, Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Room C03.236, PO Box 85500, 3508 GA Utrecht, The Netherlands; j.m.f.niermeijer{at}umcutrecht.nl

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 ⩾1 point on the Overall Disability Sum Score in 2/17 patients, an improvement of ⩾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.

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the medical ethics committee of the University Medical Centre, Utrecht.

  • Patient consent Obtained.

  • Statistical analysis was performed by JMFN.

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