Polyneuropathies Associated With IgM Monoclonal Gammopathies

Treatment experience in patients with anti–myelin‐associated glycoprotein neuropathy

“…IVIg was effective in only 3 of 19 patients (16%), a response rate that is also similar to a recently published double‐blind, placebo‐controlled trial 6. In contrast to certain series,2, 16 we found that pulse intravenous cyclophosphamide, when administered as monotherapy or combined with PE, was no more effective than other regimens. Furthermore, interferon‐α2a was effective in only 1 of 8 patients, consistent with the negative results of a recently reported double‐blind, placebo‐controlled trial 19.…”

“…However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33. Therefore, the traditional target value of a 50% reduction of the IgM paraprotein suggested in previous studies2, 16, 18, 28, 37 may be too high, and, at least in our experience, difficult to achieve and sustain.…”

“…In the small number of our patients with a sustained response, there was, however, a significant, 25% reduction of the IgM levels compared to an increase in the combined transient and nonresponder group at last follow‐up. This modest reduction is less than what has been reported following treatment with plasma exchange, cyclophosphamide and prednisone, fludarabine, and rituximab 16, 18, 27, 30, 48. However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33.…”

Treatment experience in patients with anti–myelin‐associated glycoprotein neuropathy

“…IVIg was effective in only 3 of 19 patients (16%), a response rate that is also similar to a recently published double‐blind, placebo‐controlled trial 6. In contrast to certain series,2, 16 we found that pulse intravenous cyclophosphamide, when administered as monotherapy or combined with PE, was no more effective than other regimens. Furthermore, interferon‐α2a was effective in only 1 of 8 patients, consistent with the negative results of a recently reported double‐blind, placebo‐controlled trial 19.…”

“…However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33. Therefore, the traditional target value of a 50% reduction of the IgM paraprotein suggested in previous studies2, 16, 18, 28, 37 may be too high, and, at least in our experience, difficult to achieve and sustain.…”

“…In the small number of our patients with a sustained response, there was, however, a significant, 25% reduction of the IgM levels compared to an increase in the combined transient and nonresponder group at last follow‐up. This modest reduction is less than what has been reported following treatment with plasma exchange, cyclophosphamide and prednisone, fludarabine, and rituximab 16, 18, 27, 30, 48. However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33.…”

How useful are anti-neural IgM antibodies in the diagnosis of chronic immune-mediated neuropathies?

“…Regarding individual antibodies, anti-MAG IgM antibodies were detected in 45.1% of patients with PN + IgM, confirming the previously reported prevalence of this antibody reactivity in this neuropathy [2,26,[28][29][30][31]. We also confirmed that the presence of this reactivity in patients with IgM monoclonal gammopathy was associated in 90% of the patients with a clinically manifest neuropathy.…”

Risk factors for hematological malignancy in polyneuropathy associated with monoclonal gammopathy

“…Although we found no difference in treatment response of neuropathy symptoms between patients with polyneuropathy associated with benign and malignant monoclonal gammopathy,11, 22, 34 early detection of patients with a hematological malignancy is important, as careful investigations and follow‐up may prevent serious complications and allows adequate timing of treatment. In this study, the neuropathy symptoms improved in 13 of the 19 patients treated with the accepted therapy for the underlying malignancy.…”

Treatment experience in patients with anti–myelin‐associated glycoprotein neuropathy

“…IVIg was effective in only 3 of 19 patients (16%), a response rate that is also similar to a recently published double‐blind, placebo‐controlled trial 6. In contrast to certain series,2, 16 we found that pulse intravenous cyclophosphamide, when administered as monotherapy or combined with PE, was no more effective than other regimens. Furthermore, interferon‐α2a was effective in only 1 of 8 patients, consistent with the negative results of a recently reported double‐blind, placebo‐controlled trial 19.…”

“…However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33. Therefore, the traditional target value of a 50% reduction of the IgM paraprotein suggested in previous studies2, 16, 18, 28, 37 may be too high, and, at least in our experience, difficult to achieve and sustain.…”

“…In the small number of our patients with a sustained response, there was, however, a significant, 25% reduction of the IgM levels compared to an increase in the combined transient and nonresponder group at last follow‐up. This modest reduction is less than what has been reported following treatment with plasma exchange, cyclophosphamide and prednisone, fludarabine, and rituximab 16, 18, 27, 30, 48. However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33.…”

How useful are anti-neural IgM antibodies in the diagnosis of chronic immune-mediated neuropathies?

“…Regarding individual antibodies, anti-MAG IgM antibodies were detected in 45.1% of patients with PN + IgM, confirming the previously reported prevalence of this antibody reactivity in this neuropathy [2,26,[28][29][30][31]. We also confirmed that the presence of this reactivity in patients with IgM monoclonal gammopathy was associated in 90% of the patients with a clinically manifest neuropathy.…”

Risk factors for hematological malignancy in polyneuropathy associated with monoclonal gammopathy

“…Although we found no difference in treatment response of neuropathy symptoms between patients with polyneuropathy associated with benign and malignant monoclonal gammopathy,11, 22, 34 early detection of patients with a hematological malignancy is important, as careful investigations and follow‐up may prevent serious complications and allows adequate timing of treatment. In this study, the neuropathy symptoms improved in 13 of the 19 patients treated with the accepted therapy for the underlying malignancy.…”

Treatment experience in patients with anti–myelin‐associated glycoprotein neuropathy

“…IVIg was effective in only 3 of 19 patients (16%), a response rate that is also similar to a recently published double‐blind, placebo‐controlled trial 6. In contrast to certain series,2, 16 we found that pulse intravenous cyclophosphamide, when administered as monotherapy or combined with PE, was no more effective than other regimens. Furthermore, interferon‐α2a was effective in only 1 of 8 patients, consistent with the negative results of a recently reported double‐blind, placebo‐controlled trial 19.…”

“…However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33. Therefore, the traditional target value of a 50% reduction of the IgM paraprotein suggested in previous studies2, 16, 18, 28, 37 may be too high, and, at least in our experience, difficult to achieve and sustain.…”

“…In the small number of our patients with a sustained response, there was, however, a significant, 25% reduction of the IgM levels compared to an increase in the combined transient and nonresponder group at last follow‐up. This modest reduction is less than what has been reported following treatment with plasma exchange, cyclophosphamide and prednisone, fludarabine, and rituximab 16, 18, 27, 30, 48. However, several investigators have reported no association between a clinical response and decrease in IgM levels 20, 33.…”

How useful are anti-neural IgM antibodies in the diagnosis of chronic immune-mediated neuropathies?

“…Regarding individual antibodies, anti-MAG IgM antibodies were detected in 45.1% of patients with PN + IgM, confirming the previously reported prevalence of this antibody reactivity in this neuropathy [2,26,[28][29][30][31]. We also confirmed that the presence of this reactivity in patients with IgM monoclonal gammopathy was associated in 90% of the patients with a clinically manifest neuropathy.…”

Risk factors for hematological malignancy in polyneuropathy associated with monoclonal gammopathy

“…Although we found no difference in treatment response of neuropathy symptoms between patients with polyneuropathy associated with benign and malignant monoclonal gammopathy,11, 22, 34 early detection of patients with a hematological malignancy is important, as careful investigations and follow‐up may prevent serious complications and allows adequate timing of treatment. In this study, the neuropathy symptoms improved in 13 of the 19 patients treated with the accepted therapy for the underlying malignancy.…”