CHRONIC RELAPSING POLYRADICULONEUROPATHY IN IGG-LAMBDA MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE (MGUS) - COMPLETE REMISSION FOLLOWING CARMUSTINE TREATMENT

A previously healthy 43 year-old female developed Ige lambda monoclona l gammopathy of undetermined significance (MGUS) and ascending sensori motor polyradiculoneuropathy which relapsed 11 times within 2 years. M arked improvement was noted repeatedly after plasmapheresis. However, on each occasion symptoms and signs of polyradiculoneuropathy recurred almost exactly 3 weeks after plasmapheresis. Following 6 weeks of tre atment with carmustine (70 mg/week), nearly complete recovery was esta blished, which has persisted up to now (82 months after the end of the rapy). The close temporal correlation between clinical relapse and rec urrence of the IgG paraprotein and its permanent absence in stable cli nical remission after carmustine treatment suggest a causal relationsh ip between the paraprotein and the polyradiculoneuropathy. However, fu rther studies are required to confirm this observation, as well as the efficacy of carmustine therapy.