Anti-MAG antibody-associated polyneuropathies: improvement following immunotherapy with monthly plasma exchange and IV cyclophosphamide.
Treatment outcomes of sensory-motor polyneuropathies associated with anti-myelin-associated glycoprotein (MAG) antibodies have varied even with relatively intensive immunosuppression. We used plasma exchange and cyclophosphamide to treat four patients with anti-MAG antibody-associated polyneuropathies whose symptoms had progressed in the preceding year. Treatment courses consisted of five to seven monthly regimens of plasma exchange on 2 consecutive days followed by intravenous cyclophosphamide (1 g/m2). Effects of treatment were quantitatively measured with hand-held dynamometry. All four patients showed improvement in both strength and sensation in the 5 to 24 months after treatment. We conclude that selected patients with sensory-motor polyneuropathies associated with high-titer serum IgM autoantibodies against MAG may have quantitative and useful functional improvement after immunotherapy. The improvement continues after completion of treatment and may persist for 1 to 2 years or longer.
Blume
G
G
Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.
Pestronk
A
A
Goodnough
L T
LT
D000906:Antibodies / Q000032:analysis*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009185:Myelin Proteins / Q000276:immunology*; D018992:Myelin-Associated Glycoprotein; D010523:Peripheral Nervous System Diseases / Q000276:immunology* / Q000628:therapy*; D010951:Plasma Exchange; D016896:Treatment Outcome
D000906:Antibodies; D009185:Myelin Proteins; D018992:Myelin-Associated Glycoprotein; D003520:Cyclophosphamide