Neurologische Störungen

Successfully Treated Waldenstrom Macroglobulinemia with Nine-year Follow-up: Case Report and Review of Neurologic Manifestations

Abstract

Raymond L Rosales, Melanie Leigh D Supnet, James Daniel H Villanueva and Laurence Adlai Morillo

Waldenström’s Macroglobulinemia (WM) is a rare disease, accounting for approximately 6% of all B cell lymphoproliferative disorders, with clinical features that are due to either infiltration of neoplastic cells or properties of the circulating IgM. This case report documents a Filipino-Chinese woman who had constellation of anemia, thrombocytopenia, cranial and spinal involvement, and sensory-motor polyneuropathy. Further evaluation showed clear pattern of WM demonstrated by IgM monoclonal gammopathy, presence of plasmacytoid cells on bone marrow aspirate and biopsy, and presence of B-cell markers on flow cytometry. Regimen of dexamethasone, rituximab and cyclophosphamide was given every 21 days for six courses. Follow-up studies showed negative results in serum protein and IgG electrophoresis. Repeat electrodiagnostic studies showed improved demyelinating neuropathies of the affected nerves and repeat neuroimaging showed reduction in size of the previously noted intracranial nodules and clearing of the spinal cord lesions. Appropriate treatment and follow up is very important in treating patients with WM. This report documents a serially monitored patient who remained in remission for nine years after prompt initiation of treatment. A review focusing on the neurologic sequel of WM was then performed.