Publication details

Myopatie při Waldenströmově makroglobulinemii

Title in English Myopathy in patients with Waldenström's macroglobulinemia
Authors

ADAM Zdeněk KISSOVÁ Jarmila POUR Luděk KREJČÍ Marta MICHALKOVÁ Eva KOUKALOVÁ Renata ČERMÁKOVÁ Zdeňka ČERNÁ Marta KRÁL Zdeněk MAYER Jiří

Type Article in Periodical
Magazine / Source Vnitřní lékařství
MU Faculty or unit

Faculty of Medicine

Citation
Field Oncology and hematology
Keywords Mabthera; myopathy; type IgM monoclonal immunoglobulin; Waldenström's macroglobulinemia
Description In rare cases, monoclonal immunoglobulins bind to intrinsic antigens whereby causing autoimmune damage to the body. The text describes Waldenstrom's macroglobulinemia which was manifested by muscle pain and anemia. The female pa¬tient had suffered from back pain for about 3 years before she came to our clinic. In the last year pain in the muscles of the upper and lower extremities developed in addition to back pain. This led to the suspicion of polymyositis. However this was not confirmed by a special examination. The patient was diagnosed with clearly established infiltration of lympho-plasmacytic lymphoma and 10.8 g/l of type IgM monoclonal immunoglobulin in the bone marrow. Serum myoglobin levels and serum CK activity were repeatedly significantly increased. Therefore the treatment with anti-CD20 monoclonal antibody (Mabthera) 375 mg/m2 i. v. was started, administered once a month, with cyclophosphamide 500 mg/m2 i. v. on days 1 and 15 of a 28-day cycle, and dexamethasone 20 mg from 1st through to 4th days and 15th through to 18th days of the treatment cycle. There were 8 cycles planned. Already after a 5th cycle, the disappearance of monoclonal immu noglobulin (negative immunofixation), normalisation of myoglobin and CK values and significant relief from muscle pain were achieved. The hemoglobin concentrations before treatment were significantly reduced, while they were normalised after treatment. After 5 cycles, the complete remission of Waldenstrom's disease was reached according to biochemical parameters, and normalisation of the serum myoglobin and creatine kinase levels was achieved.
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