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Antibody Binding Specificity for Kappa (Vκ) Light Chain-containing Human (IgM) Antibodies: Polysialic Acid (PSA) Attached to NCAM as a Case Study
Published on: June 29, 2016
Rituximab for polyneuropathy with IgM monoclonal gammopathy
J M F Niermeijer1, M Eurelings, H L Lokhorst
1Department of Neurology and Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands. j.m.f.niermeijer@umcutrecht.nl
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.
Conclusion:
Rituximab is a candidate for treatment of IgM MGUS polyneuropathy and should be further investigated in a double-blind randomised trial.
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