Subject(s)
COVID-19/immunology , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Lymphocyte Subsets/immunology , Vaccination/methods , Adult , Agammaglobulinaemia Tyrosine Kinase/antagonists & inhibitors , Aged , Aged, 80 and over , BNT162 Vaccine/administration & dosage , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19/virology , Case-Control Studies , ChAdOx1 nCoV-19/administration & dosage , Humans , Immunity/immunology , Immunotherapy, Adoptive/methods , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/virology , Logistic Models , Lymphocyte Subsets/metabolism , Middle Aged , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunologyABSTRACT
IgM paraprotein-associated peripheral neuropathy (PN) in patients without overt evidence of lymphoma is a recognised clinical entity of unknown aetiology. Interrogating the bone marrow B-cell or plasma cell clones underlying paraproteinemic neuropathies may improve our understanding of both pathogenesis and treatment options. This retrospective observational analysis of IgM paraprotein-associated PN identified five patients with small pathological MYD88 L265P and CD20-positive B-cell clones in their bone marrow using multi-parametric flow cytometry, who have shown durable neurological response to rituximab. We posit that multi-parametric flow cytometry may be instrumental in identifying the cellular source of the paraprotein in IgM paraprotein-associated PN, and thus directing appropriate immunomodulatory therapy. Further understanding of these small pathological B-cell clones may also provide additional insight into mechanisms of monoclonal gammopathy of clinical significance overall.
