Are neurological complications of monoclonal gammopathy of undetermined significance underestimated?

作者：Steiner Normann; Schwaerzler Angelika; Goebel Georg; Loescher Wolfgang; Wanschitz Julia; Gunsilius Eberhard^*

来源：Oncotarget, 2017, 8(3): 5081-5091.

DOI：10.18632/oncotarget.13861

• monoclonal gammopathy of undetermined significance
• MGUS
• MGUS associated neuropathy
• multiple myeloma

Objectives: Monoclonal gammopathy of undetermined significance (MGUS) is a premalignancy preceding multiple myeloma (MM) or related disorders. Neurological symptoms caused by the monoclonal immunoglobulins or free light-chains are often associated with a high morbidity. We analyzed the prevalence of neuropathy, clinical features and the long-term outcome in 223 patients (pts.) with MGUS.
Patients and Methods: Between 1/2005 and 3/2015, 223 adult pts. with MGUS were identified in our database.
Results: In36/223 pts. (16%) a neuropathy was diagnosed (MGUS associated neuropathy, MGUS-N). 20 pts. (55%) had a distal symmetric axonal neuropathy, 10pts. (28%) had a chronic inflammatory demyelinating polyneuropathy and 6 pts (17%) a distal acquired demyelinating symmetric polyneuropathy. In MGUS-NN (without neuropathy) and in MGUS-N, progression to smoldering MM, MM or Waldenstrom's macroglobulinemia (WM) occurred in 17% of the pts. The Immunoglobulin subtype was predominantly IgG in MGUS-NN and IgM in MGUS-N and >= 5.5% plasma cells in the bone-marrow predicted progression to MM and AL-amyloidosis in MGUS-NN and to WM in MGUS-N (p < 0.05).
Conclusion: Due to the substantial prevalence of neuropathies, MGUS pts. should be monitored carefully and referred to a specialized center if neurological symptoms occur.

• 出版日期2017-1-17