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NEUROLOGY 1983;33:1406
© 1983 American Academy of Neurology

Treatment of polyneuropathy in Waldenström's macroglobulinemia

Role of paraproteinemia and immunologic studies

Marinos C. Dalakas, MD, Morris A. Flaum, MD, Margaret Rick, MD, W. King Engel, MD and Harvey R. Gralnick, MD

Neuromuscular Diseases Section, Medical Neurology Branch (Drs. Dalakas and Engel) and the Hematology Section, Clinical Pathology (Drs. Flaum, Rick, and Gralnick), National Institutes of Health, Bethesda, MD.

A patient with polyneuropathy due to Waldenström's macroglobulinemia (WM) was treated successfully with chlorambucil and prednisone. Before therapy, 60% of peripheral lymphocytes were B cells, the nerve had IgMK-bearing B-cell infiltrates, and the circulating IgM had antibody-binding activity to autologous and homologous nerves. Neurologic improvement, sustained for 4 years, began 3 months after therapy and coincided with the return to normal of bone marrow and circulating B cells. Binding of IgM to autologous and homologous nerves persisted after therapy, suggesting that not the IgM alone but other B-cell factors, possibly complexed to IgM, may have been responsible for the nerve damage.

Address correspondence and reprint requests to Dr. Dalakas, Building 36, Room 5D06, NINCDS, NIH, Bethesda, MD 20205.

Presented in part at the thirty-second annual meeting of the American Academy of Neurology, New Orleans, April 1980.

Accepted for publication February 23, 1983.




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