Review Article

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Blood Res 2022; 57(S1):

Published online April 30, 2022

https://doi.org/10.5045/br.2022.2022001

© The Korean Society of Hematology

Update on the POEMS syndrome

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

Received: January 1, 2022; Revised: February 17, 2022; Accepted: February 21, 2022

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.

Abstract

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

Article

Review Article

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.

Update on the POEMS syndrome

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

Received: January 1, 2022; Revised: February 17, 2022; Accepted: February 21, 2022

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.

Abstract

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 criteriaPolyneuropathy
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 responseCR: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 responsesCR: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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