How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?

Topics: Hematologic Malignancies • Medical Oncology • Myeloma • Hematology

Answer from: Medical Oncologist at Academic Institution

I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...

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Medical Oncologist at Providence Western Washington Onc, Inc
Would there ever be a role for Plasmapheresis to t...

Medical Oncologist at University of Kansas Medical Center
I usually believe in randomized trials over person...

Answer from: Medical Oncologist at Community Practice

I think the gold standard is to do a sural nerve biopsy to look for monoclonal antibody mediated nerve damage. However, if other causes of neuropathy have been ruled out, I have empirically treated such patients without a biopsy. The goal is to prevent disability. Gabapentin and pregabalin just mask...

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Medical Oncologist at Joliet Oncology Hematology Associates
How do you follow their response?

Medical Oncologist at Valley Med Onc
That’s a challenge! It’s hard to say s...

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