Selective techniques of apheresis in polyneuropathy associated with monoclonal gammopathy of undetermined significance

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Abstract
Three cases affected by peripheral neuropathy associated to monoclonal gammopathy of undetermined significance (MGUS) were treated by using selective apheretic techniques, chosen on the basis of the serological characteristics of the gammopathy. Double filtration plasmapheresis was used in the first two cases, respectively affected by gammopathy of IgM type, kappa chains, and IgG type, lambda chains; protein A immunoadsorption in Case 3 with IgG type, lambda chains. Apheretic sessions were performed for three-four months, in association with low-dose immunosuppressive therapy. Clear and stable improvement of the neuropathy over 12-month follow-up period was observed both from a clinical and electrophysiological point of view. It is concluded that in peripheral neuropathy associated with MGUS selective techniques of apheresis can prove useful both in obtaining positive results and in avoiding the collateral effect of the original plasma exchange.