title: Rituximab for polyneuropathy with IgM monoclonal gammopathy.
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 >or=1 point on the Overall Disability Sum Score in 2/17 patients, an improvement of >or=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.
  
  
  CONCLUSIONS
  Rituximab is a candidate for treatment of IgM MGUS polyneuropathy and should be further investigated in a double-blind randomised trial.
authors.affiliation: Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands. j.m.f.niermeijer@umcutrecht.nl
authors.forename: J M F
authors.initials: JM
authors.lastname: Niermeijer
authors.forename: M
authors.initials: M
authors.lastname: Eurelings
authors.forename: H L
authors.initials: HL
authors.lastname: Lokhorst
authors.forename: W-L
authors.initials: WL
authors.lastname: van der Pol
authors.forename: H
authors.initials: H
authors.lastname: Franssen
authors.forename: J H J
authors.initials: JH
authors.lastname: Wokke
authors.forename: N C
authors.initials: NC
authors.lastname: Notermans
mesh_terms: D017668:Age of Onset; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism; D001402:B-Lymphocytes / Q000276:immunology; D001854:Bone Marrow Cells / Q000502:physiology; D003520:Cyclophosphamide / Q000627:therapeutic use; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology*; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology; D010265:Paraproteinemias / Q000188:drug therapy* / Q000276:immunology*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D000069283:Rituximab; D012677:Sensation / Q000502:physiology; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D007075:Immunoglobulin M; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone