Document Detail

Rituximab therapy in monoclonal IgM-related neuropathies.
MedLine Citation:
PMID:  16753870     Owner:  NLM     Status:  MEDLINE    
Monoclonal IgM-related neuropathies constitute a heterogeneous group of disorders, which are generally poorly responsive to treatment. Rituximab, a chimeric monoclonal antibody against the CD20 molecule, has been used with success in patients with neuropathy and monoclonal IgM with anti-MAG or anti-GM1 ganglioside activity. Based on this observation, four patients were treated with IgM-related neuropathy with rituximab. Between January 1999 - December 2000, four patients with IgM-related neuropathy (one with chronic inflammatory demyelinating polyneuropathy (CIDP) and three with sensorimotor demyelinating neuropathy) were treated with rituximab. Rituximab was administered at a standard dose of 375 mg m(-2) iv weekly for a consecutive 4 weeks; 3 months later, four additional weekly courses were administered to patients who did not experience deterioration of their neuropathy symptoms. Neurological evaluation was performed before each rituximab infusion and at 1 week and 2 months after last infusion and every 6 months the following years; including motor (MRC in six muscle groups, 9-hole peg test, 10 m walk, hand grip strength), sensory neuropathy (vibration threshold and sensory subjective score) assessment. Neurophysiological parameters were also assessed (MNCV, SNCV, CMAP, SNAP). Strength improved in three of four patients; including the patient with CIDP. This patient developed a significant worsening of her weakness 3 weeks after the initiation of rituximab. This phenomenon coincided with a serum monoclonal IgM flare and resolved spontaneously 1 week later. Her improvement is ongoing for more than 5 years. Considering neurophysiological parameters, two patients showed a slight improved regarding conduction velocities and CMAP (10%) and the patient with IgM flare had a transient worsening of conduction velocities followed by improvement. In conclusion, rituximab is a safe and well-tolerated treatment which may be effective in some patients with IgM-related neuropathy.
Constantinos Kilidireas; Athanasios Anagnostopoulos; Nikolaos Karandreas; Lefki Mouselimi; Meletios-Athanasios Dimopoulos
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Leukemia & lymphoma     Volume:  47     ISSN:  1042-8194     ISO Abbreviation:  Leuk. Lymphoma     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-06-06     Completed Date:  2006-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9007422     Medline TA:  Leuk Lymphoma     Country:  England    
Other Details:
Languages:  eng     Pagination:  859-64     Citation Subset:  IM    
Department of Neurology, Eginition Hospital, Greece.
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MeSH Terms
Antibodies, Monoclonal / administration & dosage*
Demyelinating Diseases / diagnosis,  drug therapy
Immunoglobulin M* / blood
Middle Aged
Muscle Weakness
Peripheral Nervous System Diseases / diagnosis,  drug therapy*
Sensation Disorders
Treatment Outcome
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Immunoglobulin M; 0/rituximab
Comment In:
Leuk Lymphoma. 2006 May;47(5):785-6   [PMID:  16753860 ]

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