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Semin Neurol 2025; 45(01): 099-111
DOI: 10.1055/s-0044-1791769
Review Article

Top 10 Clinical Pearls in Paraproteinemic Neuropathies

Benjamin Becker
1   Division of Neuromuscular Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
,
Amro Stino
1   Division of Neuromuscular Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan
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Abstract

Paraproteinemic neuropathies represent an important subset of peripheral neuropathies. Once identified, further evaluation into the paraproteinemic subtype, clinical exam pattern, and electrodiagnostic phenotype helps clarify if the paraproteinemia is coincidental or causal of the neuropathy, as not all paraproteinemias cause neuropathy. Of all paraproteinemias, immunoglobulin M (IgM)-associated peripheral neuropathy, or IgM neuropathy, is of particular importance as half of IgM neuropathies also harbor anti-myelin-associated glycoprotein antibodies, which produce a characteristic demyelinating pattern on nerve conduction testing. Immunoglobulin G and immunoglobulin A paraproteinemias are less strongly associated with peripheral neuropathy, except in the setting of multiple myeloma or osteosclerotic myeloma (POEMS syndrome), which have characteristic systemic features. In multiple myeloma, chemotherapy is more likely to result in neuropathy than the myeloma itself. Finally, the presence of systemic features (e.g., cardiomyopathy, nephropathy, recurrent carpal tunnel syndrome, and autonomic insufficiency) should raise concern for hereditary or acquired light (AL) chain amyloidosis. AL amyloidosis can occur in the setting of any light or heavy chain paraproteinemia. Central to the proper evaluation of paraproteinemic neuropathy is electrodiagnostic testing, which helps delineate axonal versus demyelinating paraproteinemic neuropathy, the latter often misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy.

Keywords

paraproteinemia - neuropathy - MGUS - amyloidosis - anti-MAG


Publication History

Article published online:
17 October 2024

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  • References

  • 1 Rison RA, Beydoun SR. Paraproteinemic neuropathy: a practical review. BMC Neurol 2016; 16: 13
    CrossrefPubMedSearch in Google Scholar
  • 2 Saleun JP, Vicariot M, Deroff P, Morin JF. Monoclonal gammopathies in the adult population of Finistère, France. J Clin Pathol 1982; 35 (01) 63-68
    CrossrefPubMedSearch in Google Scholar
  • 3 Crawford J, Eye MK, Cohen HJ. Evaluation of monoclonal gammopathies in the “well” elderly. Am J Med 1987; 82 (01) 39-45
    CrossrefPubMedSearch in Google Scholar
  • 4 Bharucha NE, Bharucha AE, Bharucha EP. Prevalence of peripheral neuropathy in the Parsi community of Bombay. Neurology 1991; 41 (08) 1315-1317
    CrossrefPubMedSearch in Google Scholar
  • 5 Savettieri G, Rocca WA, Salemi G. et al; Sicilian Neuro-Epidemiologic Study (SNES) Group. Prevalence of diabetic neuropathy with somatic symptoms: a door-to-door survey in two Sicilian municipalities. Neurology 1993; 43 (06) 1115-1120
    CrossrefPubMedSearch in Google Scholar
  • 6 Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care 2011; 34 (10) 2220-2224
    CrossrefPubMedSearch in Google Scholar
  • 7 Beghi EM. Italian General Practitioner Study Group (IGPSG). Chronic symmetric symptomatic polyneuropathy in the elderly: a field screening investigation in two Italian regions. I. Prevalence and general characteristics of the sample. Neurology 1995; 45 (10) 1832-1836
    CrossrefPubMedSearch in Google Scholar
  • 8 Kelly Jr JJ, Kyle RA, O'Brien PC, Dyck PJ. Prevalence of monoclonal protein in peripheral neuropathy. Neurology 1981; 31 (11) 1480-1483
    CrossrefPubMedSearch in Google Scholar
  • 9 Callaghan BC, Kerber KA, Lisabeth LL. et al. Role of neurologists and diagnostic tests on the management of distal symmetric polyneuropathy. JAMA Neurol 2014; 71 (09) 1143-1149
    CrossrefPubMedSearch in Google Scholar
  • 10 Rajabally YA. Neuropathy and paraproteins: review of a complex association. Eur J Neurol 2011; 18 (11) 1291-1298
    CrossrefPubMedSearch in Google Scholar
  • 11 Van den Bergh PYK, van Doorn PA, Hadden RDM. et al. European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: report of a joint Task Force-Second revision. J Peripher Nerv Syst 2021; 26 (03) 242-268
    CrossrefPubMedSearch in Google Scholar
  • 12 Koike H, Katsuno M. Paraproteinemia and neuropathy. Neurol Sci 2021; 42 (11) 4489-4501
    CrossrefPubMedSearch in Google Scholar
  • 13 Beydoun SR, Darki L. Paraproteinemic neuropathies. Continuum (Minneap Minn) 2023; 29 (05) 1492-1513
    PubMedSearch in Google Scholar
  • 14 Gosselin S, Kyle RA, Dyck PJ. Neuropathy associated with monoclonal gammopathies of undetermined significance. Ann Neurol 1991; 30 (01) 54-61
    CrossrefPubMedSearch in Google Scholar
  • 15 Naddaf E, Mauermann ML. Peripheral neuropathies associated with monoclonal gammopathies. Continuum (Minneap Minn) 2020; 26 (05) 1369-1383
    PubMedSearch in Google Scholar
  • 16 Kyle RA, Therneau TM, Rajkumar SV. et al. Long-term follow-up of IgM monoclonal gammopathy of undetermined significance. Blood 2003; 102 (10) 3759-3764
    CrossrefPubMedSearch in Google Scholar
  • 17 Rajkumar SV, Dimopoulos MA, Palumbo A. et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15 (12) e538-e548
    CrossrefPubMedSearch in Google Scholar
  • 18 Kyle RA, Larson DR, Therneau TM. et al. Long-term follow-up of monoclonal gammopathy of undetermined significance. N Engl J Med 2018; 378 (03) 241-249
    CrossrefPubMedSearch in Google Scholar
  • 19 International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol 2003; 121 (05) 749-757
    CrossrefPubMedSearch in Google Scholar
  • 20 Kyle RA, Durie BG, Rajkumar SV. et al; International Myeloma Working Group. Monoclonal gammopathy of undetermined significance (MGUS) and smoldering (asymptomatic) multiple myeloma: IMWG consensus perspectives risk factors for progression and guidelines for monitoring and management. Leukemia 2010; 24 (06) 1121-1127
    CrossrefPubMedSearch in Google Scholar
  • 21 Ríos-Tamayo R, Paiva B, Lahuerta JJ, López JM, Duarte RF. Monoclonal gammopathies of clinical significance: a critical appraisal. Cancers (Basel) 2022; 14 (21) 5247
    CrossrefPubMedSearch in Google Scholar
  • 22 Go RS, Rajkumar SV. How I manage monoclonal gammopathy of undetermined significance. Blood 2018; 131 (02) 163-173
    CrossrefPubMedSearch in Google Scholar
  • 23 Neil HA, Thompson AV, John S, McCarthy ST, Mann JI. Diabetic autonomic neuropathy: the prevalence of impaired heart rate variability in a geographically defined population. Diabet Med 1989; 6 (01) 20-24
    CrossrefPubMedSearch in Google Scholar
  • 24 Berenson JR, Anderson KC, Audell RA. et al. Monoclonal gammopathy of undetermined significance: a consensus statement. Br J Haematol 2010; 150 (01) 28-38
    CrossrefPubMedSearch in Google Scholar
  • 25 Bird J, Behrens J, Westin J. et al; Haemato-oncology Task Force of the British Committee for Standards in Haematology, UK Myeloma Forum and Nordic Myeloma Study Group. UK Myeloma Forum (UKMF) and Nordic Myeloma Study Group (NMSG): guidelines for the investigation of newly detected M-proteins and the management of monoclonal gammopathy of undetermined significance (MGUS). Br J Haematol 2009; 147 (01) 22-42
    CrossrefPubMedSearch in Google Scholar
  • 26 van de Donk NW, Palumbo A, Johnsen HE. et al; European Myeloma Network. The clinical relevance and management of monoclonal gammopathy of undetermined significance and related disorders: recommendations from the European Myeloma Network. Haematologica 2014; 99 (06) 984-996
    CrossrefPubMedSearch in Google Scholar
  • 27 England JD, Gronseth GS, Franklin G. et al; American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Academy of Physical Medicine and Rehabilitation. Practice parameter: the evaluation of distal symmetric polyneuropathy: the role of laboratory and genetic testing (an evidence-based review). Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. PM R 2009; 1 (01) 5-13
    CrossrefPubMedSearch in Google Scholar
  • 28 Dispenzieri A, Kyle R, Merlini G. et al; International Myeloma Working Group. International Myeloma Working Group guidelines for serum-free light chain analysis in multiple myeloma and related disorders. Leukemia 2009; 23 (02) 215-224
    CrossrefPubMedSearch in Google Scholar
  • 29 Kahn SN, Bina M. Sensitivity of immunofixation electrophoresis for detecting IgM paraproteins in serum. Clin Chem 1988; 34 (08) 1633-1635
    CrossrefPubMedSearch in Google Scholar
  • 30 Willrich MAV, Murray DL, Kyle RA. Laboratory testing for monoclonal gammopathies: focus on monoclonal gammopathy of undetermined significance and smoldering multiple myeloma. Clin Biochem 2018; 51: 38-47
    CrossrefPubMedSearch in Google Scholar
  • 31 Katzmann JA, Kyle RA, Benson J. et al. Screening panels for detection of monoclonal gammopathies. Clin Chem 2009; 55 (08) 1517-1522
    CrossrefPubMedSearch in Google Scholar
  • 32 Katzmann JA, Abraham RS, Dispenzieri A, Lust JA, Kyle RA. Diagnostic performance of quantitative kappa and lambda free light chain assays in clinical practice. Clin Chem 2005; 51 (05) 878-881
    CrossrefPubMedSearch in Google Scholar
  • 33 Long TE, Indridason OS, Palsson R. et al. Defining new reference intervals for serum free light chains in individuals with chronic kidney disease: results of the iStopMM study. Blood Cancer J 2022; 12 (09) 133
    CrossrefPubMedSearch in Google Scholar
  • 34 Ramchandren S, Lewis RA. An update on monoclonal gammopathy and neuropathy. Curr Neurol Neurosci Rep 2012; 12 (01) 102-110
    CrossrefPubMedSearch in Google Scholar
  • 35 Yeung KB, Thomas PK, King RH. et al. The clinical spectrum of peripheral neuropathies associated with benign monoclonal IgM, IgG and IgA paraproteinaemia. Comparative clinical, immunological and nerve biopsy findings. J Neurol 1991; 238 (07) 383-391
    CrossrefPubMedSearch in Google Scholar
  • 36 Nobile-Orazio E, Barbieri S, Baldini L. et al. Peripheral neuropathy in monoclonal gammopathy of undetermined significance: prevalence and immunopathogenetic studies. Acta Neurol Scand 1992; 85 (06) 383-390
    CrossrefPubMedSearch in Google Scholar
  • 37 Carroll AS, Lunn MPT. Paraproteinaemic neuropathy: MGUS and beyond. Pract Neurol 2021; 21 (06) 492-503
    CrossrefPubMedSearch in Google Scholar
  • 38 Chow F, Darki L, Beydoun SR. The challenge of distinguishing POEMS from chronic inflammatory demyelinating polyneuropathy - importance of early recognition and diagnosis of POEMS. US Neurol 2018; 14 (02) 94-97
    PubMedSearch in Google Scholar
  • 39 Nasu S, Misawa S, Sekiguchi Y. et al. Different neurological and physiological profiles in POEMS syndrome and chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 2012; 83 (05) 476-479
    CrossrefPubMedSearch in Google Scholar
  • 40 Lupu VD, Mora CA, Dambrosia J, Meer J, Dalakas M, Floeter MK. Terminal latency index in neuropathy with antibodies against myelin-associated glycoproteins. Muscle Nerve 2007; 35 (02) 196-202
    CrossrefPubMedSearch in Google Scholar
  • 41 Cocito D, Isoardo G, Ciaramitaro P. et al. Terminal latency index in polyneuropathy with IgM paraproteinemia and anti-MAG antibody. Muscle Nerve 2001; 24 (10) 1278-1282
    CrossrefPubMedSearch in Google Scholar
  • 42 Mathis S, Magy L, Diallo L, Boukhris S, Vallat JM. Amyloid neuropathy mimicking chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2012; 45 (01) 26-31
    CrossrefPubMedSearch in Google Scholar
  • 43 Tozza S, Severi D, Spina E. et al. The neuropathy in hereditary transthyretin amyloidosis: a narrative review. J Peripher Nerv Syst 2021; 26 (02) 155-159
    CrossrefPubMedSearch in Google Scholar
  • 44 Klein CJ, Moon JS, Mauermann ML. et al. The neuropathies of Waldenström's macroglobulinemia (WM) and IgM-MGUS. Can J Neurol Sci 2011; 38 (02) 289-295
    CrossrefPubMedSearch in Google Scholar
  • 45 Kapoor P, Rajkumar SV. Current approach to Waldenström macroglobulinemia. Blood Rev 2023; 62: 101129
    CrossrefPubMedSearch in Google Scholar
  • 46 Le Cann M, Bouhour F, Viala K. et al. CANOMAD: a neurological monoclonal gammopathy of clinical significance that benefits from B-cell-targeted therapies. Blood 2020; 136 (21) 2428-2436
    CrossrefPubMedSearch in Google Scholar
  • 47 Garcia-Santibanez R, Zaidman CM, Sommerville RB. et al. CANOMAD and other chronic ataxic neuropathies with disialosyl antibodies (CANDA). J Neurol 2018; 265 (06) 1402-1409
    CrossrefPubMedSearch in Google Scholar
  • 48 Steck AJ, Stalder AK, Renaud S. Anti-myelin-associated glycoprotein neuropathy. Curr Opin Neurol 2006; 19 (05) 458-463
    CrossrefPubMedSearch in Google Scholar
  • 49 Pruppers MHJ, Merkies ISJ, Lunn MPT, Notermans NC. IMAGiNe Study Group. 230th ENMC International Workshop: Improving future assessment and research in IgM anti-MAG peripheral neuropathy: a consensus collaborative effort, Naarden, the Netherlands, 24-26 February 2017. Neuromuscul Disord 2017; 27 (11) 1065-1072
    PubMedSearch in Google Scholar
  • 50 Vallat JM, Magy L, Sindou P, Magdelaine C, Cros D. IgG neuropathy: an immunoelectron microscopic study. J Neuropathol Exp Neurol 2005; 64 (05) 386-390
    CrossrefPubMedSearch in Google Scholar
  • 51 Vallat JM, Tabaraud F, Sindou P, Preux PM, Vandenberghe A, Steck A. Myelin widenings and MGUS-IgA: an immunoelectron microscopic study. Ann Neurol 2000; 47 (06) 808-811
    CrossrefPubMedSearch in Google Scholar
  • 52 Nobile-Orazio E, Manfredini E, Carpo M. et al. Frequency and clinical correlates of anti-neural IgM antibodies in neuropathy associated with IgM monoclonal gammopathy. Ann Neurol 1994; 36 (03) 416-424
    CrossrefPubMedSearch in Google Scholar
  • 53 Latov N. Pathogenesis and therapy of neuropathies associated with monoclonal gammopathies. Ann Neurol 1995; 37 (Suppl. 01) S32-S42
    CrossrefPubMedSearch in Google Scholar
  • 54 Vallat JM, Magy L, Ciron J, Corcia P, Le Masson G, Mathis S. Therapeutic options and management of polyneuropathy associated with anti-MAG antibodies. Expert Rev Neurother 2016; 16 (09) 1111-1119
    CrossrefPubMedSearch in Google Scholar
  • 55 Svahn J, Petiot P, Antoine JC. et al; Francophone Anti-MAG Cohort Group. Anti-MAG antibodies in 202 patients: clinicopathological and therapeutic features. J Neurol Neurosurg Psychiatry 2018; 89 (05) 499-505
    CrossrefPubMedSearch in Google Scholar
  • 56 Nobile-Orazio E, Meucci N, Baldini L, Di Troia A, Scarlato G. Long-term prognosis of neuropathy associated with anti-MAG IgM M-proteins and its relationship to immune therapies. Brain 2000; 123 (Pt 4): 710-717
    CrossrefPubMedSearch in Google Scholar
  • 57 Stino AM, Elsheikh B, Allen JA. Anti-myelin-associated glycoprotein neuropathy: Where do we stand?. Muscle Nerve 2023; 68 (06) 823-832
    CrossrefPubMedSearch in Google Scholar
  • 58 Dalakas MC, Rakocevic G, Salajegheh M. et al. Placebo-controlled trial of rituximab in IgM anti-myelin-associated glycoprotein antibody demyelinating neuropathy. Ann Neurol 2009; 65 (03) 286-293
    CrossrefPubMedSearch in Google Scholar
  • 59 Léger JM, Viala K, Nicolas G. et al; RIMAG Study Group (France and Switzerland). Placebo-controlled trial of rituximab in IgM anti-myelin-associated glycoprotein neuropathy. Neurology 2013; 80 (24) 2217-2225
    CrossrefPubMedSearch in Google Scholar
  • 60 Gorson KC, Ropper AH, Weinberg DH, Weinstein R. Treatment experience in patients with anti-myelin-associated glycoprotein neuropathy. Muscle Nerve 2001; 24 (06) 778-786
    CrossrefPubMedSearch in Google Scholar
  • 61 Comi G, Roveri L, Swan A. et al; Inflammatory Neuropathy Cause and Treatment Group. A randomised controlled trial of intravenous immunoglobulin in IgM paraprotein associated demyelinating neuropathy. J Neurol 2002; 249 (10) 1370-1377
    CrossrefPubMedSearch in Google Scholar
  • 62 Dalakas MC, Quarles RH, Farrer RG. et al. A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy. Ann Neurol 1996; 40 (05) 792-795
    CrossrefPubMedSearch in Google Scholar
  • 63 Théaudin M, Lozeron P, Lacroix C. et al. Short and long-term effect of IVIg in demyelinating neuropathy associated with MGUS, experience of a monocentric study. Rev Neurol (Paris) 2011; 167 (12) 897-904
    CrossrefPubMedSearch in Google Scholar
  • 64 Menon D, Katzberg HD, Bril V. Treatment approaches for atypical CIDP. Front Neurol 2021; 12: 653734
    CrossrefPubMedSearch in Google Scholar
  • 65 Kaku M, Berk JL. Neuropathy associated with systemic amyloidosis. Semin Neurol 2019; 39 (05) 578-588
    Thieme ConnectPubMedSearch in Google Scholar
  • 66 Gertz MA, Lacy MQ, Dispenzieri A. Amyloidosis: recognition, confirmation, prognosis, and therapy. Mayo Clin Proc 1999; 74 (05) 490-494
    CrossrefPubMedSearch in Google Scholar
  • 67 Matsuda M, Gono T, Morita H, Katoh N, Kodaira M, Ikeda S. Peripheral nerve involvement in primary systemic AL amyloidosis: a clinical and electrophysiological study. Eur J Neurol 2011; 18 (04) 604-610
    CrossrefPubMedSearch in Google Scholar
  • 68 Duston MA, Skinner M, Anderson J, Cohen AS. Peripheral neuropathy as an early marker of AL amyloidosis. Arch Intern Med 1989; 149 (02) 358-360
    CrossrefPubMedSearch in Google Scholar
  • 69 Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995; 32 (01) 45-59
    PubMedSearch in Google Scholar
  • 70 Kelly Jr JJ, Kyle RA, O'Brien PC, Dyck PJ. The natural history of peripheral neuropathy in primary systemic amyloidosis. Ann Neurol 1979; 6 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 71 Muchtar E, Gertz MA, Kyle RA. et al. A modern primer on light chain amyloidosis in 592 patients with mass spectrometry-verified typing. Mayo Clin Proc 2019; 94 (03) 472-483
    CrossrefPubMedSearch in Google Scholar
  • 72 Cueto-Garcia L, Tajik AJ, Kyle RA. et al. Serial echocardiographic observations in patients with primary systemic amyloidosis: an introduction to the concept of early (asymptomatic) amyloid infiltration of the heart. Mayo Clin Proc 1984; 59 (09) 589-597
    CrossrefPubMedSearch in Google Scholar
  • 73 Lu R, Richards TA. AL amyloidosis: unfolding a complex disease. J Adv Pract Oncol 2019; 10 (08) 813-825
    PubMedSearch in Google Scholar
  • 74 Sanchorawala V, Boccadoro M, Gertz M. et al. Guidelines for high dose chemotherapy and stem cell transplantation for systemic AL amyloidosis: EHA-ISA working group guidelines. Amyloid 2022; 29 (01) 1-7
    CrossrefPubMedSearch in Google Scholar
  • 75 Wechalekar AD, Cibeira MT, Gibbs SD. et al. Guidelines for non-transplant chemotherapy for treatment of systemic AL amyloidosis: EHA-ISA working group. Amyloid 2023; 30 (01) 3-17
    CrossrefPubMedSearch in Google Scholar
  • 76 Riefolo M, Conti M, Longhi S, Fabbrizio B, Leone O. Amyloidosis: What does pathology offer? The evolving field of tissue biopsy. Front Cardiovasc Med 2022; 9: 1081098
    CrossrefPubMedSearch in Google Scholar
  • 77 Zhang CL, Feng J, Cao XX. et al. Selection of biopsy site for patients with systematic amyloidosis. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2016; 38 (06) 706-709
    PubMedSearch in Google Scholar
  • 78 Pinton S, Vacchi E, Chiaro G. et al. Amyloid detection and typing yield of skin biopsy in systemic amyloidosis and polyneuropathy. Ann Clin Transl Neurol 2023; 10 (12) 2347-2359
    CrossrefPubMedSearch in Google Scholar
  • 79 Fine NM, Arruda-Olson AM, Dispenzieri A. et al. Yield of noncardiac biopsy for the diagnosis of transthyretin cardiac amyloidosis. Am J Cardiol 2014; 113 (10) 1723-1727
    CrossrefPubMedSearch in Google Scholar
  • 80 Garcia Y, Collins AB, Stone JR. Abdominal fat pad excisional biopsy for the diagnosis and typing of systemic amyloidosis. Hum Pathol 2018; 72: 71-79
    CrossrefPubMedSearch in Google Scholar
  • 81 Kyle RA, Spencer RJ, Dahlin DC. Value of rectal biopsy in the diagnosis of primary systemic amyloidosis. Am J Med Sci 1966; 251 (05) 501-506
    CrossrefPubMedSearch in Google Scholar
  • 82 Do Amaral B, Coelho T, Sousa A, Guimarães A. Usefulness of labial salivary gland biopsy in familial amyloid polyneuropathy Portuguese type. Amyloid 2009; 16 (04) 232-238
    CrossrefPubMedSearch in Google Scholar
  • 83 Hachulla E, Janin A, Flipo RM. et al. Labial salivary gland biopsy is a reliable test for the diagnosis of primary and secondary amyloidosis. A prospective clinical and immunohistologic study in 59 patients. Arthritis Rheum 1993; 36 (05) 691-697
    CrossrefPubMedSearch in Google Scholar
  • 84 Suzuki T, Kusumoto S, Yamashita T. et al. Labial salivary gland biopsy for diagnosing immunoglobulin light chain amyloidosis: a retrospective analysis. Ann Hematol 2016; 95 (02) 279-285
    CrossrefPubMedSearch in Google Scholar
  • 85 Gertz MA. Immunoglobulin light chain amyloidosis diagnosis and treatment algorithm 2018. Blood Cancer J 2018; 8 (05) 44
    CrossrefPubMedSearch in Google Scholar
  • 86 Vaxman I, Gertz M. Recent advances in the diagnosis, risk stratification, and management of systemic light-chain amyloidosis. Acta Haematol 2019; 141 (02) 93-106
    CrossrefPubMedSearch in Google Scholar
  • 87 Chakraborty R, Gertz MA, Dispenzieri A. et al. Natural history of amyloidosis isolated to fat and bone marrow aspirate. Br J Haematol 2017; 179 (01) 170-172
    CrossrefPubMedSearch in Google Scholar
  • 88 Kelly Jr JJ, Kyle RA, Miles JM, O'Brien PC, Dyck PJ. The spectrum of peripheral neuropathy in myeloma. Neurology 1981; 31 (01) 24-31
    CrossrefPubMedSearch in Google Scholar
  • 89 Walsh JC. The neuropathy of multiple myeloma. An electrophysiological and histological study. Arch Neurol 1971; 25 (05) 404-414
    CrossrefPubMedSearch in Google Scholar
  • 90 Malhotra P, Choudhary PP, Lal V, Varma N, Suri V, Varma S. Prevalence of peripheral neuropathy in multiple myeloma at initial diagnosis. Leuk Lymphoma 2011; 52 (11) 2135-2138
    CrossrefPubMedSearch in Google Scholar
  • 91 Richardson PG, Delforge M, Beksac M. et al. Management of treatment-emergent peripheral neuropathy in multiple myeloma. Leukemia 2012; 26 (04) 595-608
    CrossrefPubMedSearch in Google Scholar
  • 92 Rajkumar SV, Dispenzieri A, Fonseca R. et al. Thalidomide for previously untreated indolent or smoldering multiple myeloma. Leukemia 2001; 15 (08) 1274-1276
    CrossrefPubMedSearch in Google Scholar
  • 93 Rajkumar SV, Hayman S, Gertz MA. et al. Combination therapy with thalidomide plus dexamethasone for newly diagnosed myeloma. J Clin Oncol 2002; 20 (21) 4319-4323
    CrossrefPubMedSearch in Google Scholar
  • 94 Siegel D, Martin T, Nooka A. et al. Integrated safety profile of single-agent carfilzomib: experience from 526 patients enrolled in 4 phase II clinical studies. Haematologica 2013; 98 (11) 1753-1761
    CrossrefPubMedSearch in Google Scholar
  • 95 Dalla Torre C, Zambello R, Cacciavillani M. et al. Lenalidomide long-term neurotoxicity: clinical and neurophysiologic prospective study. Neurology 2016; 87 (11) 1161-1166
    CrossrefPubMedSearch in Google Scholar
  • 96 Dimopoulos MA, Leleu X, Palumbo A. et al. Expert panel consensus statement on the optimal use of pomalidomide in relapsed and refractory multiple myeloma. Leukemia 2014; 28 (08) 1573-1585
    CrossrefPubMedSearch in Google Scholar
  • 97 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
    CrossrefPubMedSearch in Google Scholar
  • 98 Mauermann ML. Paraproteinemic neuropathies. Continuum (Minneap Minn) 2014; 20 (5 Peripheral Nervous System Disorders): 1307-1322
    PubMedSearch in Google Scholar
  • 99 Khouri J, Nakashima M, Wong S. Update on the diagnosis and treatment of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome: a review. JAMA Oncol 2021; 7 (09) 1383-1391
    CrossrefPubMedSearch in Google Scholar
  • 100 Suichi T, Misawa S, Beppu M. et al. Prevalence, clinical profiles, and prognosis of POEMS syndrome in Japanese nationwide survey. Neurology 2019; 93 (10) e975-e983
    CrossrefPubMedSearch in Google Scholar
  • 101 Dispenzieri A. POEMS syndrome: 2019 update on diagnosis, risk-stratification, and management. Am J Hematol 2019; 94 (07) 812-827
    CrossrefPubMedSearch in Google Scholar
  • 102 Cerri F, Falzone YM, Riva N, Quattrini A. An update on the diagnosis and management of the polyneuropathy of POEMS syndrome. J Neurol 2019; 266 (01) 258-267
    CrossrefPubMedSearch in Google Scholar
  • 103 Li J, Zhang W, Jiao L. et al. Combination of melphalan and dexamethasone for patients with newly diagnosed POEMS syndrome. Blood 2011; 117 (24) 6445-6449
    CrossrefPubMedSearch in Google Scholar
  • 104 Briani C, Visentin A, Campagnolo M. et al. Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 2019; 24 (01) 5-18
    CrossrefPubMedSearch in Google Scholar
  • 105 Grisariu S, Avni B, Batchelor TT. et al; International Primary CNS Lymphoma Collaborative Group. Neurolymphomatosis: an International Primary CNS Lymphoma Collaborative Group report. Blood 2010; 115 (24) 5005-5011
    CrossrefPubMedSearch in Google Scholar
  • 106 Bumma N, Kahwash R, Parikh SV. et al. Multidisciplinary amyloidosis care in the era of personalized medicine. Front Neurol 2022; 13: 935936
    CrossrefPubMedSearch in Google Scholar
  • 107 Wall SA, Stevens E, Vaughn J, Bumma N, Rosko AE, Borate U. Multidisciplinary approach to older adults with hematologic malignancies - a paradigm shift. Curr Hematol Malig Rep 2022; 17 (01) 31-38
    CrossrefPubMedSearch in Google Scholar
  • 108 Mateos MV, Kumar S, Dimopoulos MA. et al. International Myeloma Working Group risk stratification model for smoldering multiple myeloma (SMM). Blood Cancer J 2020; 10 (10) 102
    CrossrefPubMedSearch in Google Scholar