CLINICAL MANIFESTATIONS

 

 

NEUROPATHY

 

Spinal cord compression (10%)

Spinal cord compression is an oncologic emergency. If compression occurs at the level of the thoracic spine, patients may develop paraparesis or paraplegia.

 

Spinal cord compression at the level of T4, documented at MRI of the spine (my personal archive). Patient was on a wheelchair, unable to deambulate.

 

 

 

A predictive tool particularly designed for elderly myeloma patients presenting with spinal cord compression.
BMC Cancer. 2016 Apr 25;16(1):292.
Rades D, Conde-Moreno AJ, Cacicedo J, Veninga T, Gebauer N, Bartscht T, Schild SE.
This is a retrospective study of 116 patients with spinal cord compression due to multiple myeloma.

 

Nerve root compression

 

Peripheral neuropathy
The most frequent types of peripheral neuropathy in MM are a distal sensorimotor neuropathy and carpal tunnel syndrome.
Peripheral neuropathy in MM may be associated with:
   - Amyloidosis
   - Neurologic paraneoplastic syndromes
   - Monoclonal immunoglobulins to myelin-associated glycoprotein (MAG)
   - POEMS syndrome
   - Drugs (thalidomide, vincristine, cisplatin)

 

Prevalence of peripheral neuropathy in multiple myeloma at initial diagnosis.
Leuk Lymphoma. 2011 Nov;52(11):2135-8.
Malhotra P, Choudhary PP, Lal V, Varma N, Suri V, Varma S.
These authors performed electrophysiological studies in 29 patients with newly diagnosed myeloma, before treatment. 18 (62%) were found to have peripheral neuropathy, usually in the form of a sensory-motor axonal neuropathy.

Subclinical peripheral neuropathy in patients with multiple myeloma before chemotherapy is correlated with decreased fingertip innervation density.
J Clin Oncol. 2014 Oct 1;32(28):3156-62.
Kosturakis AK, He Z, Li Y, Boyette-Davis JA, Shah N, Thomas SK, Zhang H, Vichaya EG, Wang XS, Wendelschafer-Crabb G, Kennedy WR, Simone DA, Cleeland CS, Dougherty PM.
Quantitative sensory tests were obtained in 29 patients with newly diagnosed multiple myeloma, before the beginning of chemotherapy. The results showed that a very high percentage (>80%) of patients had a subclinical peripheral neuropathy, with decreased peripheral innervation density.

An observational study assessing peripheral neuropathy related to multiple myeloma.
Neurol Sci. 2016 Jul;37(7):1141-3.
Leone C, Federico V, La Cesa S, Russo E, Di Stefano G, Finsinger P, Labriola R, Cruccu G, Petrucci MT, Truini A.
These authors performed neurological examination and nerve conduction studies in 153 patients with newly diagnosed myeloma, before treatment, and found that 7.2% of them had myeloma-related peripheral neuropathy.

 

 

 

MGUS AND PERIPHERAL NEUROPATHY

In patients with MGUS, IgM is the most frequent paraprotein associated with peripheral neuropathy.

Clinical features, evaluation, and treatment of patients with polyneuropathy associated with monoclonal gammopathy of undetermined significance (MGUS).
J Clin Apher. 1999;14(3):149-53.
Gorson KC.
[Review]

Review of peripheral neuropathy in plasma cell disorders.
Silberman J, Lonial S.
Hematol Oncol. 2008 Jun;26(2):55-65.
[Review]

Neuropathies associated with IgG and IgA monoclonal gammopathy.
Rev Neurol (Paris). 2002 Oct;158(10 Pt 1):979-87.
Nobile-Orazio E, Casellato C, Di Troia A.
[Review]

IgM MGUS associated with anti-MAG neuropathy: a single institution experience.
Talamo G., Mir M.A., Pandey M.K., Sivik J.K., Raheja D. 
Ann Hematol, 2015; 94:1011.

 

 


Giampaolo Talamo, M.D.