How do you manage IgM related peripheral neuropathy?  

First things first, let's make sure it's IgM related. In patients with precursor disease (MGUS or smoldering) and neuropathy, I check B12, HbA1c, TSH, free T4, hepatitis B surface Ag, hepatitis B total core Ab, hepatitis C antibody, and cryoglobulins. In patients with specific risk factors, I check ...

I see a number of these cases and I can tell you what I have learned through experience. When the underlying process is LPL/waldenstrom’s, single agent Rituximab for 4 weekly doses can be highly effective. I give it six months to see improvement. I track IgM and not the MAG antibodies for imp...