Are neurological complications of monoclonal gammopathy of undetermined significance underestimated?
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Normann Steiner1, Angelika Schwärzler1, Georg Göbel3, Wolfgang Löscher2, Julia Wanschitz2,*, Eberhard Gunsilius1,*
1Department of Internal Medicine V (Hematology and Medical Oncology), Medical University of Innsbruck, A-6020 Innsbruck, Austria
2Department of Neurology, Medical University of Innsbruck, A-6020 Innsbruck, Austria
3Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, A-6020 Innsbruck, Austria
*These authors have contributed equally to this work
Eberhard Gunsilius, email: [email protected]
Keywords: monoclonal gammopathy of undetermined significance, MGUS, MGUS associated neuropathy, multiple myeloma
Received: June 21, 2016 Accepted: November 21, 2016 Published: December 10, 2016
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, 10 pts. (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.
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