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Review
. 2017 May;92(5):838-850.
doi: 10.1016/j.mayocp.2017.02.003.

Monoclonal Gammopathy-Associated Peripheral Neuropathy: Diagnosis and Management

Hafsa M Chaudhry  1 , Michelle L Mauermann  2 , S Vincent Rajkumar  3
Affiliations
Review

Monoclonal Gammopathy-Associated Peripheral Neuropathy: Diagnosis and Management

Hafsa M Chaudhry et al. Mayo Clin Proc. 2017 May.

Abstract

Monoclonal gammopathies comprise a spectrum of clonal plasma cell disorders that include monoclonal gammopathy of undetermined significance, multiple myeloma, and Waldenström macroglobulinemia. In this review, we outline the epidemiology, etiology, classification, diagnosis, and treatment of monoclonal gammopathy-associated peripheral neuropathy. Monoclonal gammopathy of undetermined significance is relatively common in the general population, with a prevalence of 3% to 4% among individuals older than age 50 years. Therefore, the presence of M protein in a patient with neuropathy does not automatically indicate a causal relationship. Monoclonal gammopathy-associated peripheral neuropathy is often a difficult diagnosis with limited treatment options. Studies addressing the optimal approach to diagnosis and management of this entity are limited. In addition to a review of the literature, we present a diagnostic approach to patients with monoclonal gammopathy-associated peripheral neuropathy and discuss available data and options for treatment.

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Conflict of interest statement

Disclosure of Conflicts of Interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Approach to Evaluation of a Patient with a Monoclonal Protein identified in conjunction with Peripheral Neuropathy *Based on history, physical examination, and if appropriate, laboratory and radiographic testing †This group includes patients with multiple myeloma who have concurrent peripheral neuropathy. These patients need therapy to eradicate the neoplastic clone due to the nature of the malignancy in contrast to patients with monoclonal gammopathy of undetermined significance in whom establishing a causal relationship between neuropathy and the monoclonal protein is critical for therapeutic purposes. POEMS, polyneuropathy, osteosclerotic myeloma, endocrinopathy, monoclonal protein, skin changes.
Figure 2
Figure 2
Approach to Management of Monoclonal Gammopathy Associated Peripheral Neuropathy *High probability of monoclonal gammopathy associated peripheral neuropathy after excluding other causes of peripheral neuropathy, POEMS syndrome, and AL amyloid neuropathy. Neuropathy considered severe and/or progressive enough to warrant intervention †Unlikely that M protein is causally related to neuropathy; most associations are likely coincidental. DADS, distal, acquired, demyelinating, symmetric neuropathy; IVIG, intravenous immune globulin; CIDP, chronic inflammatory demyelinating polyneuropathy
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References

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