1
|
Guérémy A, Boucraut J, Boudjarane J, Grapperon AM, Fortanier E, Farnault L, Gabert J, Vely F, Lacroix R, Kouton L, Attarian S, Delmont E. Clinical, biological, electrophysiological and therapeutic profile of patients with anti-MAG neuropathy according to MYD88 L265P and CXCR4 mutations and underlying haemopathy. J Neurol 2024; 271:1320-1330. [PMID: 37979093 DOI: 10.1007/s00415-023-12068-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Anti-MAG neuropathies are associated with an IgM monoclonal gammopathy of undetermined significance (MGUS) or with a malignant haemopathy. Our objective was to determine whether the presence of a haemopathy or somatic mutations of MYD88 and CXCR4 genes influences disease presentation and response to rituximab (RTX). METHODS We included 79 patients (mean age 74 years, disease duration 9.68 years) who had a bone marrow aspiration with morphologic and immunophenotypic analysis. MYD88L265P and CXCR4 mutations were analysed in peripheral B cells. Information collected included: inflammatory neuropathy cause and treatment sensory sum score (ISS), MRC testing, overall neuropathy limitation scale (ONLS), Rash-built Overall Disability Score (RODS), ataxia score, anti-MAG titres, peak IgM dosage, neurofilament light chain levels, motor and sensory amplitudes, motor unit index (MUNIX) and motor unit size index (MUSIX) sum scores. Efficacy of RTX was evaluated at 12 months in 26 patients. RESULTS Malignant haematological disorders were discovered in 17 patients (22%): 13 Waldenstrom macroglobulinemia, 3 marginal zone lymphoma and one mantle cell lymphoma. MYD88L265P mutation was detected in 29/60 (48%) patients and CXCR4 in 1 single patient. Disease severity, biological and electrophysiological data and response to RTX were comparable in patients with MGUS/lymphoma and patients with/without MYD88L265P mutation. ISS was lower and MUSIX higher in patients improved by RTX. CONCLUSIONS MYD88L265P mutation and underlying haemopathies are not predictive of a more severe disease. However, in cases of resistant and progressive neuropathy, they provide an opportunity to prescribe newly available drugs such as Bruton tyrosine kinase inhibitors.
Collapse
Affiliation(s)
- Alexandre Guérémy
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - José Boucraut
- APHM, Hôpital de La Timone, Service d'Immunologie, Marseille-Immunopole, Marseille, France
- AMU, Institut de Neurosciences des Systèmes (INS, UMR1106), Marseille, France
| | - John Boudjarane
- Laboratory of Constitutional Cytogenetics, Department of Medical Genetics, La Timone Hospital Marseille, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Etienne Fortanier
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Laure Farnault
- Haematology and Cellular Therapy Department, La Conception, University Hospital of Marseille, Marseille, France
- APHM Head of Biochemistry and Molecular Biology, Hopital Nord chemin des Bourrely, 13015, Marseille, France
| | - Jean Gabert
- INT Bd Jean Moulin Aix-Marseille University UMR7289, Marseille, France
- Aix-Marseille University, CNRS, INSERM, CIML, Marseille, France
| | - Frédéric Vely
- APHM, Hôpital de La Timone, Service d'Immunologie, Marseille-Immunopole, Marseille, France
- Aix-Marseille University, CNRS, INSERM, CIML, Marseille, France
| | - Romaric Lacroix
- Center for CardioVascular and Nutrition Research (C2VN), Faculty of Medical and Paramedical Sciences, Aix-Marseille University, National Institute of Health and Medical Research (INSERM), National Research Institute for Agriculture, Food and Environment (INRAE), 13005, Marseille, France
- Laboratoire d'Hématologie et de Biologie Vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Ludivine Kouton
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, Hospital La Timone, 264 Rue Saint Pierre, 13005, Marseille, France.
| |
Collapse
|
2
|
Min YG, Han HJ, Shin HY, Baek JG, Kim JS, Park KS, Baek SH, Yoo I, Huh SY, Kwon YN, Choi SJ, Kim SM, Hong YH, Sung JJ. Therapeutic Outcomes and Electrophysiological Biomarkers in Anti-Myelin-Associated Glycoprotein Neuropathy: A Multicenter Cohort Study in South Korea. J Clin Neurol 2024; 20:50-58. [PMID: 38179632 PMCID: PMC10782088 DOI: 10.3988/jcn.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND PURPOSE Unlike other immune-mediated neuropathies, anti-myelin-associated glycoprotein (MAG) neuropathy is often refractory to immunotherapy. It is necessary to compare the relative efficacies of various immunotherapies and develop objective biomarkers in order to optimize its clinical management. METHODS This study recruited 91 patients with high anti-MAG antibody titers from 7 tertiary hospitals in South Korea. We analyzed the baseline characteristics, therapeutic outcomes, and nerve conduction study (NCS) findings of 68 patients and excluded 23 false positive cases. RESULTS The rate of positive responses to treatment was highest using zanubrutinib (50%) and rituximab (36.4%), followed by corticosteroids (16.7%), immunosuppressants (9.5%), intravenous immunoglobulin (5%), and plasma exchange (0%). Disability and weakness were significantly associated with multiple NCS parameters at the time of diagnosis, especially distal compound muscle action potential (CMAP) amplitudes. Moreover, the longitudinal trajectory of the average CMAP amplitudes paralleled the clinical courses, with a 16.2 percentile decrease as an optimal cutoff for predicting a clinical exacerbation (area under the receiver operating characteristic curve=0.792). CONCLUSIONS Our study supports the use of NCS as an objective marker for estimating disease burden and tracking clinical changes in patients with anti-MAG neuropathy. We have described the beneficial effects of rituximab and a new drug, zanubrutinib, compared with conventional immunotherapies.
Collapse
Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hee-Jo Han
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Gyu Baek
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ilhan Yoo
- Department of Neurology, Nowon Eulji Medical Center, Seoul, Korea
| | - So-Young Huh
- Department of Neurology, Kosin Medical University Hospital, Busan, Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Yoon-Ho Hong
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
3
|
Horta LFB, Edwards CV, Kaku MC, Lau KHV. Clinical Reasoning: A 67-Year-Old Woman With Progressive Tingling Sensations and Imbalance. Neurology 2023; 100:151-157. [PMID: 36302667 DOI: 10.1212/wnl.0000000000201624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/12/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Camille V Edwards
- From the Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA
| | - Michelle C Kaku
- From the Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA
| | - K H Vincent Lau
- From the Department of Neurology, Boston Medical Center, Boston University School of Medicine, MA
| |
Collapse
|
4
|
Parisi M, Dogliotti I, Clerico M, Bertuzzo D, Benevolo G, Orsucci L, Schiavetti I, Cavallo R, Cavallo F, Ragaini S, Di Liberto A, Ferrante M, Bondielli G, Artusi CA, Drandi D, Lopiano L, Ferrero B, Ferrero S. Efficacy of rituximab in anti-myelin-associated glycoprotein demyelinating polyneuropathy: Clinical, hematological and neurophysiological correlations during 2 years of follow-up. Eur J Neurol 2022; 29:3611-3622. [PMID: 36083713 PMCID: PMC9825860 DOI: 10.1111/ene.15553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE We evaluated the clinical and neurophysiological efficacy of rituximab (RTX) in a neurophysiologically homogeneous group of patients with monoclonal gammopathy and immunoglobulin M (IgM) anti-myelin-associated glycoprotein antibody (anti-MAG) demyelinating polyneuropathy. METHODS Twenty three anti-MAG-positive polyneuropathic patients were prospectively evaluated before and for 2 years after treatment with RTX 375 mg/m2 . The Inflammatory Neuropathy Cause and Treatment (INCAT) disability scale (INCAT-ds), modified INCAT sensory score (mISS), Medical Research Council sum score, Patients' Global Impression of Change scale were used, IgM levels were assessed and extensive electrophysiological examinations were performed before (T0) and 1 year (T1) and 2 years (T2) after RTX treatment. RESULTS At T1 and T2 there was a significant reduction from T0 both in mISS and in INCAT-ds, with a p value < 0.001 in the inferential Friedman's test overall analysis. Ulnar nerve Terminal Latency Index and distal motor latency significantly changed from T0 to T1 and in the overall analysis (p = 0.001 and p = 0.002), and ulnar nerve sensory nerve action potential (SNAP) amplitude was significantly increased at T2 from T1, with a p value < 0.001 in the overall analysis. Analysis of the receiver-operating characteristic curves showed that a 41.8% increase in SNAP amplitude in the ulnar nerve at T2 from T0 was a fair predictor of a mISS reduction of ≥2 points (area under the curve 0.85; p = 0.005; sensitivity: 90.9%, specificity: 83.3%). CONCLUSIONS This study suggests that RTX is effective in patients with clinically active demyelinating anti-MAG neuropathy over 2 years of follow-up, and that some neurophysiological variables might be useful for monitoring this efficacy.
Collapse
Affiliation(s)
- Mattia Parisi
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Irene Dogliotti
- Stem Cell Transplant UnitUniversity Hospital A.O.U. “Città della Salute e della Scienza di Torino”TurinItaly
| | - Michele Clerico
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Giulia Benevolo
- SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Lorella Orsucci
- Division of Hematology 2A.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Irene Schiavetti
- Section of Biostatistics, Department of Health SciencesUniversity of GenoaGenoaItaly
| | - Roberto Cavallo
- Department of NeurologyOspedale San Giovanni BoscoTurinItaly
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | - Simone Ragaini
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| | | | - Martina Ferrante
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | - Giulia Bondielli
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Daniela Drandi
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly
| | | | - Bruno Ferrero
- Department of NeurosciencesUniversity of TurinTurinItaly
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health SciencesUniversity of TurinTurinItaly,SSD Myeloma Unit and Clinical Trial, University HaematologyA.O.U. "Città della Salute e della Scienza di Torino"TurinItaly
| |
Collapse
|
5
|
Koide K, Sugiyama A, Yokota H, Mukai H, Wang J, Nakamura K, Misawa S, Ito S, Kuwabara S. Nerve Hypertrophy and Altered Diffusion in Anti-Myelin-Associated Glycoprotein Neuropathy Detected by Brachial Plexus Magnetic Resonance Neurography. Eur Neurol 2021; 85:95-103. [PMID: 34583351 DOI: 10.1159/000519128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. METHODS Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. RESULTS There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. CONCLUSIONS Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.
Collapse
Affiliation(s)
- Kyosuke Koide
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan,
| | - Atsuhiko Sugiyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Mukai
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Jiaqi Wang
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Nakamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
6
|
Bourque PR, Masson-Roy J, Warman-Chardon J, Massie R, Melanson M, Brooks J, Breiner A. Temporal evolution of nerve conduction study abnormalities in anti-myelin-associated glycoprotein neuropathy. Muscle Nerve 2020; 63:401-404. [PMID: 33290607 DOI: 10.1002/mus.27134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND A distal-predominant demyelinating symmetric pattern is most frequent in patients with neuropathy associated with anti-myelin-associated glycoprotein (MAG) antibodies. The literature however lacks longitudinal data to describe whether this is consistent over time. METHODS From the Ottawa Neuromuscular Center database, we identified 23 patients with both immunoglobulin M gammopathy and anti-MAG antibodies. For median, ulnar and fibular motor conduction studies, we analyzed distal latency and amplitude, negative peak duration, terminal latency index (TLI), and conduction velocity. For median, ulnar, sural, and superficial fibular sensory conduction studies, we analyzed distal latency and amplitude. Results were compared for the earliest and the latest data sets. RESULTS The mean time interval between the two assessment points was 6.5 years. Median and ulnar motor nerve conduction studies did not show a significant change for any of the parameters tested. There was disproportionate prolongation of median distal motor latency and reduction in TLI, compared to the ulnar nerve. Deep fibular motor conduction studies showed a marked reduction in amplitudes over time. Sensory potentials were recordable in the upper limb in less than 50% at the first study and less than 25% on the most recent study. There was an even larger attrition of recordable sural and superficial fibular sensory potentials. CONCLUSIONS Our results highlight the stability of median and ulnar motor conduction study results over a mean observation period of 6.5 years. In contrast, lower limb motor and all sensory potentials show a marked trend toward becoming unrecordable.
Collapse
Affiliation(s)
- Pierre R Bourque
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Josée Masson-Roy
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rami Massie
- Department of Neurology, McGill University, Montreal, Québec, Canada
| | - Michel Melanson
- Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - John Brooks
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
7
|
Mathis S, Duval F, Soulages A, Solé G, Le Masson G. The ataxic neuropathies. J Neurol 2020; 268:3675-3689. [DOI: 10.1007/s00415-020-09994-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022]
|