Submitted by: Justin Willer, MD
Edited by: Nakul Katyal, MD
Citation: Matthys A, Bardel B, Le Bras F, et al. Rate and characteristics of inflammatory neuropathies associated with brentuximab vedotin therapy. Eur J Neurol. 2024;31(7):e16285. doi:10.1111/ene.16285
Summary: Brentuximab (BV) is used for treatment of lymphoma. BV-induced neuropathy was defined as the occurrence of neuropathy up to 3 months after BV discontinuation. Criteria were adapted from EAN/PNS criteria for chronic inflammatory demyelinating polyneuropathy.
Classic BV-induced neuropathy (BV-CN) is a mild form of distal sensory axonal polyneuropathy, while a more severe type known as BV-induced inflammatory neuropathy (BV-IN) has also been reported. Among 83 patients, 49% developed neuropathy; 35 BV-CN and 6 BV-IN. Most patients experienced isolated symptoms such as paresthesias or pain in either the upper or lower limbs. The classic form tends to progress more gradually, whereas the inflammatory form often presents acutely or subacutely.
BV-IN compared to the classic form more frequently had muscle weakness (67% vs 5.7 %) and gait disorders (83% vs 20%). The BV-IN compared to BV-CN was more frequently severe (50% vs 0%). Diffuse areflexia was reported in 5 of the 6 patients with BV-IN, but occurred insufficiently in the classic form to make a statistical comparison. Two patients with BV-IN had clear cut demyelination with elevated cerebrospinal fluid protein. The others had a more distal or sensory predominant presentation, with motor nerve conduction studies only weakly indicating possible demyelination.
Motor conduction block was more common in the inflammatory type (28% vs 0%) and motor velocities tended to be lower and distal latencies tended to be higher. BV was discontinued for six patients with inflammatory type neuropathy. Of the six, two patients responded to IVIG, one responded to IV steroids and plasma exchange, one responded to oral steroids, one improved spontaneously, and one died from mycosis fungoides before immunotherapy could be instituted.
Comments: Severe inflammatory BV-CN should be considered in the differential diagnosis for lymphoma patients who experience paresthesias. Other differentials include lymphoma-related neuropathy, paraproteinemic neuropathy, paraneoplastic neuropathy, and neurolymphomatosis. BV-IN should be included in the differential of a disabling neuropathy in patients receiving BV.
