Document Detail


The neuropathies of Waldenström's macroglobulinemia (WM) and IgM-MGUS.
MedLine Citation:
PMID:  21320835     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Neuropathy is common in Waldenström's macroglobulinemia (WM, an IgM-associated lymphoplasmacytic lymphoma) and in IgM-monoclonal gammopathy of undetermined significance (IgM-MGUS). Paraneoplastic or paraimmune mechanisms are thought to be involved in the pathogenesis of these neuropathies. Attempts at distinguishing WM and IgM-MGUS neuropathies are lacking especially among bone marrow (BM) confirmed patients.
METHODS: Retrospective analyses were performed on BM confirmed WM (N=30) and IgM-MGUS (N=73) neuropathy patients with neurologic assessments and hematologic features.
RESULTS: The presence of anemia and quantity of IgM monoclonal protein were significantly greater in WM. Based on multiple neurologic assessments differences were not found for: 1) length of time from neurologic symptom onset to evaluation; 2) chief complaint of painless loss of feeling in the feet, Romberg's sign and tremor; and 3) clinical motor, sensory and reflex abnormalities. Autonomic testing was normal in both diseases. Using nerve conduction (NCS) criteria for demyelination, 62% of IgM-MGUS and 27% of WM met this criteria (p=0.013). IgM MGUS patients had greater terminal conduction slowing by ulnar residual latency calculation (<0.01). The degree of axonal loss as measured by summated compound muscle action potentials and available nerve biopsy was not significantly different between diseases.
CONCLUSION: Although WM and IgM-MGUS must be distinguished for hematologic prognosis and treatment, clinical neuropathy presentations of WM and IgM-MGUS are similar and likely related to comparable axonal loss in both conditions. Despite these similarities, evidence of demyelination was found by electrophysiologic studies much more commonly in IgM-MGUS. This difference may reflect varied immune mechanism(s) in the two disorders.
Authors:
Christopher J Klein; Joon-Shik Moon; Michelle L Mauermann; Steven R Zeldenrust; Yanhong Wu; Angela Dispenzieri; Peter J Dyck
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques     Volume:  38     ISSN:  0317-1671     ISO Abbreviation:  Can J Neurol Sci     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-15     Completed Date:  2011-05-12     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  0415227     Medline TA:  Can J Neurol Sci     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  289-95     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Axons / pathology,  physiology
Female
Hemoglobins / metabolism
Humans
Immunoglobulin M / blood*
Male
Middle Aged
Neural Conduction / physiology
Paraproteinemias / complications*,  diagnosis,  immunology*
Polyneuropathies / etiology*,  immunology,  physiopathology
Retrospective Studies
Statistics, Nonparametric
Sural Nerve / pathology,  ultrastructure
Waldenstrom Macroglobulinemia / complications*,  diagnosis
Grant Support
ID/Acronym/Agency:
K08 NS065007/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Hemoglobins; 0/Immunoglobulin M
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