Clinical, Electrophysiological, and Neuropathological Features of Peripheral Neuropathies in People With T-Cell Lymphoproliferative Disorder

BACKGROUND AND OBJECTIVES: Peripheral neuropathies (PNs) associated with T-cell lymphoproliferative disorders (T-Ly) are exceptionally rare and poorly characterized. Whether their mechanisms, clinical features, and outcome differ from PN associated with B-cell lymphoproliferative disorders (B-Ly) remains unclear. We aimed to characterize the clinical, electrophysiologic, and pathologic spectrum of T-Ly-associated PN, evaluate treatment responses, and compare these findings with B-Ly-associated PN. METHODS: We conducted a retrospective multicentric cohort study across 17 PN reference centers in France and Switzerland. Adult patients with confirmed PN and T-Ly were included after exclusion of alternative PN etiologies and isolated CNS involvement. Clinical, electrophysiologic, imaging, and histopathologic data were collected. PN were classified as neurolymphomatosis or dysimmune neuropathy based on multidisciplinary consensus. Functional outcomes were assessed using the modified Rankin Scale (mRS) and Overall Neuropathy Limitations Scale. The results were compared with a reference cohort of B-Ly-associated PN. DISCUSSION: T-Ly-associated PN are predominantly driven by neurolymphomatosis and exhibit more severe clinical profiles and poorer neurologic outcomes than B-Ly-associated PN. Dysimmune neuropathies represent a substantial subset, particularly in angioimmunoblastic T-cell lymphoma. Limitations include the retrospective design and heterogeneity of diagnostic investigations. These findings underscore the need for early recognition and mechanism-specific therapeutic strategies.