title: Long-term response to rituximab and fludarabine combination in IgM anti-myelin-associated glycoprotein neuropathy.
abstract: We report the clinical response and biological effects of treatment with rituximab and fludarabine (RF) in five patients with IgM anti-myelin-associated glycoprotein (MAG) demyelinating neuropathy. Between November 2006 and October 2009, four men and one woman aged 52-85 years received intravenous rituximab at 375 mg/m(2)  on day 1 and oral fludarabine at 40 mg/m(2) /day from days 1 to 5, in a treatment cycle that was repeated every month for up to 6 months. Two patients had IgM monoclonal gammopathy of undetermined significance and three low tumor mass Waldenstrom's macroglobulinemia. Four patients showed a major hematological response with a decrease in anti-MAG titer in three and clearing in one. One patient did not respond. For the responding patients, symptoms and electrophysiological parameters improved significantly. No patient relapsed at post-RF treatment follow-up (12-45 months), and no toxicity was reported. The combination of RF induced significant responses in IgM anti-MAG demyelinating neuropathies, without toxicity. Clinical improvements were correlated to hematological and immunological results.
authors: Hematology Department, University Hospital, Amiens, France.
authors: Berengere
authors: B
authors: Gruson
authors: Kamel
authors: K
authors: Ghomari
authors: Marie
authors: M
authors: Beaumont
authors: Reda
authors: R
authors: Garidi
authors: Alain
authors: A
authors: Just
authors: Philippe
authors: P
authors: Merle
authors: Lavinia
authors: L
authors: Merlusca
authors: Jean P
authors: JP
authors: Marolleau
authors: Bruno
authors: B
authors: Royer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D001324:Autoantigens / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018992:Myelin-Associated Glycoprotein / Q000276:immunology; D010265:Paraproteinemias / Q000097:blood / Q000188:drug therapy / Q000276:immunology; D011129:Polyradiculoneuropathy / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D000069283:Rituximab; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D001323:Autoantibodies; D001324:Autoantigens; D007075:Immunoglobulin M; D007155:Immunologic Factors; D018992:Myelin-Associated Glycoprotein; D000069283:Rituximab; D014740:Vidarabine; C024352:fludarabine