Rituximab for polyneuropathy with IgM monoclonal gammopathy
- J M F Niermeijer1,
- M Eurelings1,
- H L Lokhorst2,
- W-L van der Pol1,
- H Franssen1,
- J H J Wokke1,
- N C Notermans1
- 1Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center, Utrecht, The Netherlands
- 2Department of Haematology, University Medical Center, Utrecht, The Netherlands
- 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
- Received 5 June 2008
- Revised 14 July 2008
- Accepted 27 July 2008
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.
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.
