Revisiting the spectrum of IgM-related neuropathies in a large cohort of IgM monoclonal gammopathy.

Benjamin Bardel, Valérie Molinier-Frenkel, Fabien Le Bras, Samar S Ayache, Tarik Nordine, Jean-Pascal Lefaucheur, Violaine Planté-Bordeneuve

Journal of neurology 2022 Sep

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A significant number of patients with a peripheral neuropathy have IgM monoclonal gammopathy (IgM-MG). In this work, we encompassed the spectrum and outcome of IgM-related neuropathies (IgM-NP) in a large monocentric cohort of patients with IgM-MG. We retrospectively reviewed the neurological and hematological findings and the course of neuropathy in all patients with IgM-MG over a five-year period in our center (Henri Mondor hospital, Assistance Publique Hôpitaux de Paris (APHP), France). Among 550 patients with IgM-MG, 83 patients (15%) had IgM-NP (55 males, mean age 67 y.o.). The median serum level of IgM-MG was 3.4 g/L, mostly kappa light chain component. The hematological diagnosis was Monoclonal Gammopathy of Undetermined Significance (MGUS) in 62 patients. Anti-MAG antibodies were detected in 38 patients with heterogeneous clinical and neurophysiological features. Four patients had neurolymphomatosis presenting as a non-length dependent predominantly motor neuropathy, which occurred long after the finding of IgM-MG and was responsive to hematological treatment. Five patients had an AL amyloid neuropathy revealed by a small fiber neuropathy. Finally, 30 patients were classified as "Neuropathy of Uncertain Relationship with the IgM" (NURIM) with characteristics close to those of an anti-MAG-NP at the time of diagnosis, except for the neurophysiological features with a predominant axonal pattern. This study emphasizes the wide spectrum of IgM-NP associated with a variety of hematological diagnoses. In particular, the course and prognosis vary considerably. In this setting, further studies are needed to unravel the group of patients classified as NURIM. © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

Citation

Benjamin Bardel, Valérie Molinier-Frenkel, Fabien Le Bras, Samar S Ayache, Tarik Nordine, Jean-Pascal Lefaucheur, Violaine Planté-Bordeneuve. Revisiting the spectrum of IgM-related neuropathies in a large cohort of IgM monoclonal gammopathy. Journal of neurology. 2022 Sep;269(9):4955-4960