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Yasuda H, Tomizawa Y, Harada S, Sasaki M, Komatsu N, Ando J, Hattori N, Ando M. Anti-myelin-associated-glycoprotein neuropathy successfully treated with tirabrutinib. Heliyon 2022; 8:e10928. [PMID: 36247137 PMCID: PMC9557899 DOI: 10.1016/j.heliyon.2022.e10928] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/11/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Anti-myelin-associated-glycoprotein (MAG) neuropathy is a distal, predominantly demyelinating, sensory or sensory-motor polyneuropathy most often developing in the context of an IgM-type monoclonal gammopathy due to monoclonal gammopathy of undetermined significance or lymphoplasmacytic lymphoma. Rituximab is considered standard therapy for treatment naïve patients, but optimal treatment methods for relapsed/refractory patients have not been established. Case presentation We demonstrate that tirabrutinib, a second-generation Burton kinase inhibitor, led to drastic improvements of polyneuropathy that were affirmed by nerve conduction studies in a rituximab-refractory anti-MAG neuropathy patient. Tirabrutinib continues to give excellent disease control with no apparent adverse events at 11 months since initiation, and the patient remains free of plasmapheresis sessions which were originally mandatory. Conclusion Tirabrutinib is an extremely promising treatment option for anti-MAG neuropathy.
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Affiliation(s)
- Hajime Yasuda
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Corresponding author.
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sakiko Harada
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Makoto Sasaki
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Laboratory for the Development of Therapies Against MPN, Juntendo University School of Medicine, Japan
- Department of Advanced Hematology, Juntendo University School of Medicine, Japan
| | - Jun Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Cell Therapy and Transfusion Medicine, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Miki Ando
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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Nivet T, Baptiste A, Belin L, Ghillani-Dalbin P, Algrin C, Choquet S, Lamy T, Morel V, Musset L, Roos-Weil D, Viala K, Leblond V, Baron M. Immunochemotherapy versus rituximab in anti-myelin-associated glycoprotein neuropathy: A report of 64 patients. Br J Haematol 2022; 198:298-306. [PMID: 35420717 DOI: 10.1111/bjh.18202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023]
Abstract
Monoclonal immunoglobulin M (IgM) anti-myelin-associated glycoprotein (MAG) neuropathy is a rare disabling condition, most commonly treated with rituximab monotherapy (R), which leads to neurological improvement in only 30%-50% of patients. The combination of rituximab plus chemotherapy has been proven to improve the level of responses. We studied the outcomes of anti-MAG neuropathy patients treated either by R, or by immunochemotherapy (ICT) in our centre, focusing on the incidence of the first neurological response evaluated by the modified Rankin scale (mRS). From 2011 to 2018, 64 patients were studied: 34 were treated with R and 30 with ICT. According to our treatment decision-making process, the median mRS was higher in the ICT group (mRS 2) than in the R group (mRS 1). At one year, improvements of the mRS rates were 46% and 18% in the ICT and R groups of patients respectively, with median times to response of eight and 13 months (p = 0.023). Adverse effects were higher in the ICT group: 62% vs 15% (p ˂ 0.01), all grades included. One secondary acute leukaemia occurred five years after treatment with ICT. In conclusion, ICT may be used as a valid option for patients with rapidly progressive and/or severe anti-MAG neuropathy symptoms.
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Affiliation(s)
- Thomas Nivet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France.,Department of Hematology, CHU de Rennes, Rennes, France
| | - Amandine Baptiste
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Lisa Belin
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascale Ghillani-Dalbin
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Caroline Algrin
- Department of Hematology, Groupe Hospitalier mutualiste de Grenoble, Grenoble, France
| | - Sylvain Choquet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Thierry Lamy
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Véronique Morel
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Lucile Musset
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Roos-Weil
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Karine Viala
- Department of Neurophysiology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Véronique Leblond
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Marine Baron
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
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Bendamustine–rituximab (BR) combined therapy for treatment of immuno-mediated neuropathies associated with hematologic malignancy. J Neurol Sci 2020; 413:116777. [DOI: 10.1016/j.jns.2020.116777] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/14/2020] [Accepted: 03/13/2020] [Indexed: 02/03/2023]
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Abstract
Waldenstrom macroglobulinemia (WM) is a lymphoplasmacytic lymphoma that presents with symptomatic anemia, thrombocytopenia, constitutional symptoms, extramedullary disease and rarely hyperviscosity syndrome. The presence of both IgM monoclonal protein and ≥10% monoclonal lymphoplasmacytic cells is required for the diagnosis. MyD88 is present in 67-90% of patients but is not pathognomonic for WM. Many patients who fulfill the criteria of WM are asymptomatic and do not require treatment. Recent advances in the understanding of the biology of WM have paved the way for new treatment options. The use of novel agents with or without rituximab enables the use of effective chemotherapy-free regiments upfront and in the relapsed setting. New targeted treatments such as venetoclax and CXCR4 antagonists are being investigated.
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Affiliation(s)
- Iuliana Vaxman
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah- Tikva, Israel.,Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Morie Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Ueki S, Nakamura M, Sasaki R, Okada Y, Yoshikawa K, Kusunoki S, Ishii K, Kusaka H, Kondo T. Beneficial Effect of Bendamustine in a Patient with Anti-MAG/SGPG Neuropathy and Bing-Neel Syndrome Associated with Waldenström Macroglobulinemia: A Case Report. Case Rep Neurol 2018; 10:88-94. [PMID: 29983700 PMCID: PMC6031954 DOI: 10.1159/000487850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/20/2018] [Indexed: 01/02/2023] Open
Abstract
A 71-year-old man with Waldenström macroglobulinemia (WM) presented with a slowly progressive sensory disturbance and mild weakness predominantly affecting the distal portion of the limbs over the course of 6 months. Cervical magnetic resonance imaging (MRI) showed a long hyperintense lesion at the C1–C4 level. Nerve conduction studies (NCS) revealed prolongation of distal latency, slowed conduction velocity, and conduction block. His serum IgM level was increased, and he was positive for anti-myelin-associated glycoprotein (MAG) and anti-sulfoglucuronyl paragloboside (SGPG) IgM antibodies. Based on the presence of anti-MAG/SGPG antibodies and a single atypical cell with lymphoplasmacytic character in the cerebral spinal fluid, he was diagnosed as having anti-MAG/SGPG neuropathy and Bing-Neel syndrome (BNS) associated with WM. Following 6 cycles of bendamustine monotherapy, the patient's neurological impairment improved; and the serum IgM level became normalized. Furthermore, NCS findings indicated improvement; and the hyperintense lesion on MRI had almost completely disappeared. The present findings suggest that bendamustine monotherapy is effective not only for WM but also for its associated MAG/SGPG neuropathy and BNS.
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Affiliation(s)
- Syugo Ueki
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Masataka Nakamura
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan.,Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Risa Sasaki
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Yoichiro Okada
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Keisuke Yoshikawa
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Kazuyoshi Ishii
- Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Hirofumi Kusaka
- Department of Neurology, Kansai Medical University, Hirakata, Japan
| | - Takayuki Kondo
- Department of Neurology, Kansai Medical University Medical Center, Moriguchi, Japan
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Nobile-Orazio E, Bianco M, Nozza A. Advances in the Treatment of Paraproteinemic Neuropathy. Curr Treat Options Neurol 2017; 19:43. [DOI: 10.1007/s11940-017-0479-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Nobile-Orazio E, Gallia F, Terenghi F, Bianco M. Comparing treatment options for chronic inflammatory neuropathies and choosing the right treatment plan. Expert Rev Neurother 2017; 17:755-765. [DOI: 10.1080/14737175.2017.1340832] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eduardo Nobile-Orazio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Francesca Gallia
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Fabrizia Terenghi
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Mariangela Bianco
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
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