Abstract
The aim of this study was to determine the effects of plasma exchange (PE) associated with Chlorambucil in the treatment of peripheral neuropathies in four patients suffering from Waldenström's disease (three cases with IgM kappa paraproteinemia and one case with IgM lambda). Before PE therapy, there was a severe slowing down of the motor and sensory conduction velocities (MCV and SCV) in three cases (IgM kappa) and a less severe slowing in one case (IgM lambda). In three cases, PE rapidly (as early as the third or the fourth administration) brought about a moderate improvement in the MCV and SCV, especially in the upper limbs, whereas in one case, no effect was noted. Clinically, the paraesthesias and dysaesthesias diminished, but the deep tendon reflexes remained absent or markedly depressed. Three months after the PE, nerve conduction velocities were again very reduced. The current literature on the physiopathological mechanisms of the peripheral neuropathies in the Waldenström's disease and the effects of the treatment by immunosuppressive agents and PE are reviewed.
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