CLL and Neuropathy

The Professors' Posts

Neuropathy

TERRY HAMBLIN

I have just written a review of paraneoplastic conditions in CLL.

My conclusions are that peripheral neuropathy in CLL can be neoplastic, paraneoplastic or unrelated.

Neoplastic - There are certainly some reports of CLL cells infiltrating the nerve. This is very rare and usually occurs in very advanced disease.

Paraneoplastic - Several people (including myself) have reported cases where a peripheral neuropathy occurred in a patient with CLL. The relationship with CLL is a matter of speculation. Possible mechanisms include autoimmunity and immunodeficiency allowing a viral cause. If the neuropathy occurred after treatment with Fludarabine, I would be inclined to favour an autoimmune cause. If it occurred in a patient who was suffering other manifestations of immunodeficiency, like recurrent herpes infections, then I would favour this being the mechanism.

Unrelated - of course the two conditions might occur together incidentally.

TERRY HAMBLIN

Neuropathy

Those technical terms again!

Someone has asked what neuropathy is.

It means that the nerves are not working properly. Nerves are long white
cords that take sensory messages to the brain and motor messages from the brain
to the muscles.

If it is a sensory neuropathy then sensation is affected. This means that
normal sensations like touch, pain, hot and cold, vibration, position sense
don't get through to consciousness. The patient might feel numb or a sensation of
pins and needles.

If it is a motor neuropathy the muscles don't receive the message to move so
there is paralysis or weakness.

There are dozens of causes of neuropathy - diabetes is probably the commonest
sensory neuropathy. Polio used to be the commonest form of motor neuropathy.

In CLL you are most likely to come across drug induced neuropathy -
vincristine is one of the most likely drugs. Bell's Palsy, which is a neuropathy of
the nerve that supplies the muscles of the face is caused by infections of
Herpes Simplex and is not uncommon in CLL.

Neuropathy caused by CLL is rare, but there has been a recent report of CLL
cells infiltrating the nerves of the legs and causing weakness and altered
sensation.

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