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Comparative Study
. 2021 Mar;26(1):75-82.
doi: 10.1111/jns.12428. Epub 2021 Jan 10.

Comparing neuropathy in multiple myeloma and AL amyloidosis

Martin Ballegaard  1   2   3 , Laerke Marie Nelson  4 , Peter Gimsing  2   5
Affiliations
Comparative Study

Comparing neuropathy in multiple myeloma and AL amyloidosis

Martin Ballegaard et al. J Peripher Nerv Syst. 2021 Mar.

Abstract

Peripheral neuropathy (PN) is frequent in patients with monoclonal gammopathy due to plasma cell dyscrasia, but little is known about the comparative impact of nerve dysfunction in different disorders. We compared clinical and laboratory results between two diagnostic groups. We recruited 76 untreated multiple myeloma (MM) and 27 AL amyloidosis (ALA) patients for evaluation of symptoms, clinical findings and nerve conduction studies (NCS). We diagnosed significant PN using total neuropathy scores (TNS > 7) in 17.6% of MM and 48.1% of ALA patients and in 27.7% of MM and 35.7% of ALA patients using NCS findings. TNS score grades were significantly higher in the AL amyloidosis patients (Fisher's exact test: P = .02) but a NCS based PN diagnosis was not significantly different (Fisher's exact test: P = .13). A significantly higher TNS vibration (P = .04) and pin (P = .02) sensory sign and TNS reflex (P = .04) sign score was found in amyloidosis patients. Likewise, quantitative sensory thresholds for vibration was higher in amyloidosis patients (Welsh ANOVA: P = .01). NCS revealed signs of more frequent axonal tibial neuropathy with significantly lower motor response amplitudes (P = .02) and resulting higher TNS scores (P = .002), while sural nerve sensory response amplitudes were without significant difference (P = .86). We found more severe TNS grades of PN in AL amyloidosis patients compared with MM patients. We also found higher sensory symptoms scores and higher thresholds for vibration but similar sensory involvement using NCS. The NCS exclusively showed signs of an axonal neuropathy.

Keywords: AL amyloidosis; multiple myeloma; nerve conduction study; peripheral nervous system disease; total neuropathy score.

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References

REFERENCES

    1. Lozeron P, Adams D. Monoclonal gammopathy and neuropathy. Curr Opin Neurol. 2007;20(5):536-541. https://doi.org/10.1097/WCO.0b013e3282ef79e3.
    1. Eurelings M, Lokhorst HM, Kalmijn S, Wokke JHJ, Notermans NC. Malignant transformation in polyneuropathy associated with monoclonal gammopathy. Neurology. 2005;64(12):2079-2084. https://doi.org/10.1212/01.WNL.0000176296.79088.9A.
    1. Van Schaik IN, Léger JM, Nobile-Orazio E, et al. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society. J Peripher Nerv Syst. 2010;15(4):295-301. https://doi.org/10.1111/j.1529-8027.2010.00290.x.
    1. Richardson PG, Briemberg H, Jagannath S, et al. Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol. 2006;24(19):3113-3120. https://doi.org/10.1200/JCO.2005.04.7779.
    1. Richardson PG, Xie W, Mitsiades C, et al. Single-agent bortezomib in previously untreated multiple myeloma: efficacy, characterization of peripheral neuropathy, and molecular correlations with response and neuropathy. J Clin Oncol. 2009;27(21):3518-3525. https://doi.org/10.1200/JCO.2008.18.3087.

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