Blood Res 2022; 57(S1):
Published online April 30, 2022
https://doi.org/10.5045/br.2022.2022001
© The Korean Society of Hematology
Correspondence to : Yu Ri Kim, M.D., Ph.D.
Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Yonsei-ro, Seoul 03722, Korea
E-mail: glassy@yuhs.ac
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
POEMS syndrome is an acronym for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. It is a rare paraneoplastic disorder related to plasma cell neoplasm. However, its pathophysiology has not yet been clearly elucidated. The production of pro-inflammatory cytokines is thought to play an important role in the pathogenesis of POEMS syndrome. Vascular endothelial growth factor level reflects disease activity, which is helpful for the diagnosis and evaluation of treatment response. Conventional agents such as corticosteroids and melphalan are effective and safe combination regimens. Autologous hematopoietic stem cell transplantation is another option for high-risk transplant-eligible patients. Radiotherapy is effective in patients with localized lesions. The anti-myeloma agents lenalidomide, thalidomide, and bortezomib have shown good treatment outcomes for POEMS syndrome; however, large-scale studies with long-term follow-up are required. Early identification and active treatment can improve the outcomes of POEMS syndrome patients.
Keywords POEMS syndrome, Polyneuropathy, Transplantation, Vascular endothelial growth factor
Blood Res 2022; 57(S1): S27-S31
Published online April 30, 2022 https://doi.org/10.5045/br.2022.2022001
Copyright © The Korean Society of Hematology.
Yu Ri Kim
Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
Correspondence to:Yu Ri Kim, M.D., Ph.D.
Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Yonsei-ro, Seoul 03722, Korea
E-mail: glassy@yuhs.ac
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
POEMS syndrome is an acronym for polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. It is a rare paraneoplastic disorder related to plasma cell neoplasm. However, its pathophysiology has not yet been clearly elucidated. The production of pro-inflammatory cytokines is thought to play an important role in the pathogenesis of POEMS syndrome. Vascular endothelial growth factor level reflects disease activity, which is helpful for the diagnosis and evaluation of treatment response. Conventional agents such as corticosteroids and melphalan are effective and safe combination regimens. Autologous hematopoietic stem cell transplantation is another option for high-risk transplant-eligible patients. Radiotherapy is effective in patients with localized lesions. The anti-myeloma agents lenalidomide, thalidomide, and bortezomib have shown good treatment outcomes for POEMS syndrome; however, large-scale studies with long-term follow-up are required. Early identification and active treatment can improve the outcomes of POEMS syndrome patients.
Keywords: POEMS syndrome, Polyneuropathy, Transplantation, Vascular endothelial growth factor
Table 1 . Diagnostic criteria..
Mandatory major criteria | Polyneuropathy |
Monoclonal plasma cell proliferative disorder (almost always l) | |
Any one of the following three other major criteria: | Sclerotic bone lesions |
Castleman’s disease | |
Elevated levels of VEGF | |
Any one of the following six minor criteria: | Organomegaly (splenomegaly, hepatomegaly, or lymphadenopathy) |
Extravascular volume overload (edema, pleural effusion, or ascites) | |
Endocrinopathy (adrenal, thyroid, pituitary, gonadal, parathyroid, pancreatic) | |
Skin changes (hyperpigmentation, hypertrichosis, glomeruloid hemangioma, plethora, acrocyanosis, flushing, white nails) | |
Papilledema | |
Thrombocytosis/polycythemia |
Table 2 . Response criteria..
Hematologic response | CR:negative bone marrow and negative immunofixation of serum and urine |
VGPR:over 90% reduction in M-protein, plus urine M-protein level of <100 mg per 24-h | |
PR:50% reduction in M-protein or positive immunofixation as long as the baseline M protein is at least 1.0 g/dL | |
PET responses | CR:the disappearance of all FDG uptake lesions |
PR:≥50% improvement in the sum of the maximum standardized uptake value of FDG-avid lesions | |
No response:the failure to meet CR or PR criteria | |
VEGF response (evaluable: ×2 UNL) | CR:normalization of VEGF |
PR:a decrease of over 50% VEGF | |
No response:the failure to meet CR or PR criteria | |
Progression:50% increase from the lowest level | |
Clinical response (clinical improvement, clinical progression, mixed clinical response, and clinical stability) | Peripheral neuropathy, organomegaly, papilledema, erythrocytosis/thrombocytosis, endocrinopathy, extravascular fluid overload (ascites, effusions, edema) |
Pulmonary function tests |
Abbreviations: CR, complete response; PR, partial response; UNL, upper normal limit; VGPR,very good partial response..
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