Auto-antibodies in Myeloma Patients with Peripheral Neuropathy

Abstract

Background - Peripheral neuropathy is a known complication of multiple myeloma. Incidence of peripheral neuropathy increases with the use of certain drugs ( eg: Thalidomide, Bortezomib ). It was hypothesised that the reason for neuropathy in myeloma due to autoantibody damage on the nerve tissue. Aim of the study was to determine the specific types of paraneoplastic auto-antibodies and anti-ganglioside antibodies and the presence of such auto-antibodies using antigenic targets in monkey cerebellum. Patients and Methods - 377 myeloma patients with peripheral neuropathy were selected from MRC myeloma trial IX. The age range was 3 I to 90. The sex ratio was 241: 136 Blood samples were collected at the time of recruiting and six years later. There were only 269 patients at the end of six years. Serum samples were stored following a precise laboratory procedure till the tests were done. Samples were tested for paraneoplastic auto-antibodies (Ma2, Yo) and antigen targets in monkey cerebellum using indirect immunofluorescence and western blots. Serum samples were also screened for seven types of anti-ganglioside antibodies using western blots. Results - 43 patients (11 %) had antibodies against cerebellum. Five were positive to paraneoplastic auto-antibodies (Ma2). Anti-ganglioside antibodies were detected in 30 (8% ). Only IgM were found in 26, lgG and IgM in 3 and IgG in I. Conclusion - Significant number of myeloma patients with neuropathy has antibody against nerve tissues. Discussion - Sample consists of elderly, neuropathy is a common occurrence in elderly. Research is ongoing with different sample of myeloma patients without neuropathy, who are tested for the specific auto-antibodies. Detected unidentified antibody patterns need further investigation.