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              <text>&lt;a href="http://doi.org/10.1097/RHU.0b013e3182155e8d" target="_blank" rel="noreferrer noopener"&gt;http://doi.org/10.1097/RHU.0b013e3182155e8d&lt;/a&gt;</text>
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                <text>Type 1 Cryoglobulinemia Response to Thalidomide and Lenalidomide</text>
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                <text>therapy; Rheumatology; patient; criteria; imids; multiple-myeloma; poems-syndrome; vasculitis; waldenstroms macroglobulinemia</text>
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                <text>Among the varying etiologies of cryoglobulinemia (Cg), type I Cg represents the rarest form and is most often associated with lymphoproliferative disorders such as non-Hodgkin lymphoma, Waldenstrom macroglobulinemia, or multiple myeloma. Clinical manifestations are generally those of small-vessel vasculitis and/or hyperviscosity. The treatment of patients with type 1 disease generally consists of chemotherapy directed at the lymphoproliferative disorder or varying levels of empiric immunosuppression including apheresis, glucocorticoids, and cytotoxic agents. In recent years, anecdotes of biologic and/or immunomodulatory therapy with rituximab and thalidomide have been reported.(1-4) Occasionally. patients present with severe type 1 cryoglobulinemic disease in the absence of a defined malignancy but with monoclonal gammopathy of otherwise undetermined significance (MGUS); the treatment of such patients is controversial.(5,6) We recently treated such a patient with traditional immunosuppressives and rituximab but found him ultimately to respond only to thalidomide and its congener, lenalidomide.</text>
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