A Phase II Trial of Rituximab for Peripheral Neuropathy Associated With Monoclonal Gammopathy of Undetermined Significance (MGUS)
OBJECTIVES:
- To evaluate whether rituximab therapy can produce an improvement in symptoms, signs,
and disability in patients with IgM monoclonal gammopathy of undetermined significance
(MGUS) neuropathy with or without anti-myelin-associated glycoprotein reactivity.
- To assess if patients with IgG- or IgA-associated MGUS neuropathies respond to
rituximab.
- To determine whether 25-foot timed walking test results correlate with neuropathy
impairment score, summated compound muscle action potential (CMAP) amplitude, or
modified Rankin scale as a measure of motor function in patients with peripheral
neuropathy.
- To gain information regarding the toxicity of rituximab in this patient population.
OUTLINE: Patients receive rituximab IV on days 1, 8, 15, and 22. Patients with neuropathy
progression at 6 months (as indicated by an increase in the Neuropathy Impairment Score
[NIS] of ≥ 10 or a modified Rankin Score increase of > 1 grade) are taken off study.
Patients with stable or responding neuropathy (NIS of < 10 or a modified Rankin Score
increase of < 1 grade) receive a second course of rituximab. Treatment continues in the
absence of disease progression or unacceptable toxicity.
After completion of study therapy, patients are followed at 6 months.
DISEASE CHARACTERISTICS:
- Diagnosis of monoclonal gammopathy of undetermined significance (MGUS), as evidenced
by 1 of the following criteria:
- Documented monoclonal protein in the serum (< 3 g/dL) or urine
- Monoclonal serum free light chain, with at least 50% of patients having an
immunoglobulin M (IgM) paraprotein (the balance being immunoglobulin G (IgG) or
immunoglobulin A (IgA) subtypes)
- Neuropathy Impairment Score (NIS) ≥ 25
- Stable or progressive neuropathy (i.e., not currently improving), as judged by NIS
values that have not fallen ≥ 10 (between enrollment and the last documented value),
at least 1 month but not greater than 3 months prior to enrollment
- No evidence of amyloidosis or overt lymphoma, overt myeloma, or Waldenström
macroglobulinemia with end organ damage
- No evidence of multiple myeloma, Amyloid Light-chain (AL)-amyloidosis
- No evidence of Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy,
and skin changes (POEMS) syndrome, diabetes mellitus, alcohol induced neuropathy,
untreated hypothyroidism, vitamin B12 deficiency, Sjögren syndrome, and other causes
of neuropathy
PATIENT CHARACTERISTICS:
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
The proportion of patients having sustained a successful response, as measured by the neuropathy impairment score (NIS) at 6 months
6 months after baseline
No
Benn E. Smith, MD
Principal Investigator
Mayo Clinic
United States: Institutional Review Board
1191-04
NCT00588822
December 2007
March 2010
Name | Location |
---|---|
Mayo Clinic Scottsdale | Scottsdale, Arizona 85259 |
Mayo Clinic - Jacksonville | Jacksonville, Florida 32224 |
Mayo Clinic Cancer Center | Rochester, Minnesota 55905 |