UP FRONT
Hematology Link
In today’s health-care environment, no practitioner operates in a silo – and
that is particularly true for hematology. In “Hematology Link,” we will speak
with an outside specialist to examine where these medical specialties and
hematology meet.
Managing Peripheral Neuropathy
In this edition, ASH Clinical News
speaks with Brian C. Callaghan,
MD, about managing peripheral
neuropathy in patients with hematologic diseases. Dr. Callahan
is assistant professor of neurology at the University of Michigan
Health System in Ann Arbor,
Michigan.
How does peripheral neuropathy manifest?
Brian C. Callaghan, MD
Peripheral neuropathy usually causes
numbness, tingling, pain, and weakness that
starts in the toes and rises to the level of the
knees, before starting in the hands. Atypical
neuropathies can be asymmetric, motorpredominant, start in the hands and feet at
the same time, and cause autonomic symptoms. Symptoms and clinical presentation of
treatment-emergent peripheral neuropathy
can also differ based on the type of treatment.
Do you treat many patients experiencing peripheral neuropathy who also have
hematologic disease?
We do see many patients with peripheral
neuropathy as a result of hematologic diseases or the treatments for these conditions.
As hematologists/oncologists very well
know, many chemotherapeutic agents can
cause neuropathy; chemotherapy-induced
peripheral neuropathy is the most common
scenario in which patients with hematologic
malignancies develop this condition.
Peripheral neuropathy is also a frequent
complication of plasma-cell disorders, such
as multiple myeloma, amyloidosis, POEMS
(polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin
changes) syndrome, and Waldenström macroglobulinemia. In these cases, the peripheral nerves are one of many involved sites
of the disease. The hematologic condition
most commonly associated with peripheral
neuropathy is monoclonal gammopathy of
unknown significance (MGUS).
Patients with peripheral neuropathy
have a high prevalence of monoclonal
proteins; therefore, guidelines from the
American Academy of Neurology recommend routine serum protein electrophoresis (SPEP) testing with immunofixation in
these patients.
Peripheral neuropathy is a common complication of hematologic disease – is there
a causal relationship?
The current understanding is that the
proteins associated with the hematologic
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ASH Clinical News
diseases noted previously are directly
pathologic to the nerves. We are in need
of better information about factors that
predispose patients to peripheral neuropathy. However, there are several known
variables and comorbidities also associated with its development: the presence of
diabetes mellitus, alcohol abuse, vitamin
deficiencies, and viral infections.
What