Rituximab for polyneuropathy with IgM monoclonal gammopathy.
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.
Niermeijer
J M F
JM
Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands. j.m.f.niermeijer@umcutrecht.nl
Eurelings
M
M
Lokhorst
H L
HL
van der Pol
W-L
WL
Franssen
H
H
Wokke
J H J
JH
Notermans
N C
NC
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
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