101
|
Sodavarapu S, Mahajan A. Ischemic Stroke in a Patient With Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Protein, and Skin Changes Syndrome Treated With Lenalidomide. Cureus 2020; 12:e9346. [PMID: 32850219 PMCID: PMC7444892 DOI: 10.7759/cureus.9346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is an uncommon multisystemic disease associated with plasma cell dyscrasia. Due to the disease's rarity and an even rarer presentation of stroke in afflicted patients, a direct association between POEMS syndrome and stroke remains ambiguous. Thrombocytosis, hyperfibrinogenemia, and increased levels of inflammatory cytokines occur in this disease, which can predispose patients to thromboembolic events. Immunomodulators can also enhance thrombosis, the chances of which increase when they are combined with dexamethasone. We present a case of a 28-year-old patient with an ischemic stroke, which may have been triggered by the combination of POEMS syndrome-associated vasculitis and the thrombogenic nature of lenalidomide-dexamethasone therapy.
Collapse
Affiliation(s)
| | - Arshian Mahajan
- Family Medicine, San Joaquin General Hsopital, French Camp, USA
| |
Collapse
|
102
|
Monoclonal Gammopathy of Undetermined Significance (MGUS)-Not So Asymptomatic after All. Cancers (Basel) 2020; 12:cancers12061554. [PMID: 32545521 PMCID: PMC7352603 DOI: 10.3390/cancers12061554] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Monoclonal Gammopathy of Undetermined Significance (MGUS) is considered to be a benign precursor condition that may progress to a lymphoproliferative disease or multiple myeloma. Most patients do not progress to an overt condition, but nevertheless, MGUS is associated with a shortened life expectancy and, in a minority of cases, a number of co-morbid conditions that include an increased fracture risk, renal impairment, peripheral neuropathy, secondary immunodeficiency, and cardiovascular disease. This review aims to consolidate current evidence for the significance of these co-morbidities before considering how best to approach these symptoms and signs, which are often encountered in primary care or within a number of specialties in secondary care.
Collapse
|
103
|
Lau YH, Mohd Unit H, Lee LP, Loh WK, Hiew FL. Temporal dispersion in demyelination of POEMS syndrome and Castleman disease. Clin Neurophysiol Pract 2020; 5:112-117. [PMID: 32613149 PMCID: PMC7322354 DOI: 10.1016/j.cnp.2020.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022] Open
Abstract
Objective We detailed the electrophysiological patterns of peripheral nerve temporal dispersion across spectrum of POEMS syndrome and Castleman disease (CD). Methods Compound muscle action potentials (CMAP) duration of 3 patients with POEMS syndrome and 2 with hyaline vascular type CD without clonal plasma cell dyscrasia were retrospectively analysed. Results Median and ulnar nerves distal CMAP duration were prolonged in all patients irrespective of plasma cell dyscrasia or M protein. All lower limbs distal CMAP responses were absent. Greatest distal CMAP duration prolongation was observed in median nerves for POEMS syndrome (17.0 ms, 158% upper limit normal) and in ulnar nerves for CD (9.8 ms, 47% upper limit normal). Distal/proximal CMAP duration ratio of <0.7 were seen in 33% of median and ulnar nerves studied among POEMS syndrome. Among nerves with ratio >0.7, all had distal CMAP duration prolongation (Range 7%-158% of upper limit normal). Conclusions Abnormal distal CMAP dispersion is not uncommon in POEMS syndrome and CD without clonal plasma cell dyscrasia or M protein. POEMS syndrome has greater distal CMAP duration in median and ulnar nerves, particularly in median nerve that can reach up to 150% of upper limit normal, compared to <50% in CD. Significance Detailed electrophysiological analysis of distal CMAP duration may help in distinguishing POEMS syndrome and CD.
Collapse
Key Words
- CD, Castleman disease
- CIDP, Chronic inflammatory demyelinating polyneuropathy
- CMAP duration
- CMAP, Compound muscle action potentials
- Castleman disease
- Demyelination
- M Protein, Monoclonal protein
- MGUS, Monoclonal gammopathy of undetermined significance
- NCS, Nerve conduction study
- POEMS syndrome
- POEMS syndrome, Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes Syndrome
- Paraproteinemic neuropathy
- SNAP, Sensory nerve action potentials
- TLI, Terminal latency index
- Temporal Dispersion
- VEGF, Vascular endothelial growth factor
- ms, milliseconds
Collapse
Affiliation(s)
- Yue Hui Lau
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Hazfadzila Mohd Unit
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Lay Peng Lee
- Department of Medicine, Sibu Hospital, KM 5 1/2, Jalan Ulu Oya, 96000 Sarawak, Malaysia
| | - Weng Khean Loh
- Haematology Unit, Department of Medicine, Kuala Lumpur Hospital, Jalan Pahang, 50586, Wilayah Persekutuan, Kuala Lumpur, Malaysia
| | - Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Jalan Pahang, 50586, Wilayah Persekutuan, Kuala Lumpur, Malaysia
- Corresponding author.
| |
Collapse
|
104
|
Suichi T, Misawa S, Nagashima K, Sato Y, Iwai Y, Katayama K, Sekiguchi Y, Shibuya K, Amino H, Suzuki YI, Tsuneyama A, Nakamura K, Kuwabara S. Lenalidomide Treatment for Thalidomide-refractory POEMS Syndrome: A Prospective Single-arm Clinical Trial. Intern Med 2020; 59:1149-1153. [PMID: 32009091 PMCID: PMC7270764 DOI: 10.2169/internalmedicine.3800-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective A randomized controlled trial has shown the efficacy of thalidomide against polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome; however, there are still refractory patients. We studied the effects of lenalidomide, a derivative of thalidomide, on patients refractory to thalidomide. Methods This prospective single-arm trial evaluated the safety and efficacy of lenalidomide plus dexamethasone in refractory or recurrent patients with POEMS syndrome. The regimen was administered as six 28-day cycles with lenalidomide on days 1-21 (15 mg in cycle 1, and 25 mg in cycle 2-6) plus dexamethasone once a week (20 mg). The primary endpoints were the rate of reduction in the serum vascular endothelial growth factor (VEGF) level at 24 weeks and the incidence of adverse events. This trial was registered with ClinicalTrial.gov, NCT02193698. Results Between July 2014 and December 2015, five men were enrolled. All patients had been refractory to thalidomide plus dexamethasone for more than 24 weeks. The mean rate of reduction in the serum VEGF level at 24 weeks was 59.6%±8.3% (p=0.0003). The mean serum VEGF level decreased from 2,466±771 pg/mL to 974±340 pg/mL. No serious adverse events were observed, and all patients completed six cycles treatment. Discussion Lenalidomide is a therapeutic option for thalidomide-refractory patients with POEMS syndrome.
Collapse
Affiliation(s)
- Tomoki Suichi
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Sonoko Misawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Kengo Nagashima
- Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Japan
| | - Yuta Iwai
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | | | - Yukari Sekiguchi
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Hiroshi Amino
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Yo-Ichi Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Atsuko Tsuneyama
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Keigo Nakamura
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
105
|
Lin Q, Wei J, Qian J, You L, Qian W. Somatic Mutations Confer Severe Peripheral Neuropathy in POEMS Syndrome-Associated Multicentric Castleman Disease. Neurosci Bull 2020; 36:664-666. [PMID: 32166648 DOI: 10.1007/s12264-020-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Qingqing Lin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Juying Wei
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Liangshun You
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Wenbin Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| |
Collapse
|
106
|
Yang H, Zhao H, Gao X, Huang X, Cao X, Zhou D, Xia W, Li J. Endocrine Evaluation in POEMS Syndrome: A Cohort Study. Front Endocrinol (Lausanne) 2020; 11:536241. [PMID: 33193075 PMCID: PMC7654174 DOI: 10.3389/fendo.2020.536241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 08/27/2020] [Indexed: 11/30/2022] Open
Abstract
Endocrinopathy is an important characteristic of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome. However, endocrine responses to different regimens were unknown so far. Here we investigated endocrine characteristics in 383 patients with newly diagnosed POEMS syndrome and thyroid responses 1 year after treatment with autologous peripheral stem cell transplantation, melphalan plus dexamethasone, or lenalidomide plus dexamethasone. Overt hypothyroidism and subclinical hypothyroidism were noted in 20.6% (79/383) and 36.0% (138/383) of patients. Adrenal insufficiency was noted in 13.6% (43/316) of patients. Hyperprolactinemia was noted in 62.7% (207/330) of patients. Hypogonadism was noted in 48.0% (60/125) of female and 22.6% (51/226) of male patients. Thyroid function was significantly related with baseline risk stratification (p < 0.001) and significantly improved regardless of initial regimens. Patients with baseline hypothyroidism had a significant inferior progression-free survival (PFS) (p = 0.028) and overall survival (OS) (p = 0.006). Three-year PFS in patients with and without baseline hypothyroidism were 68.9 vs. 82.5%, respectively. Three-year OS rates in patients with and without baseline hypothyroidism were 82.8 vs. 92.8%, respectively. In summary, hypothyroidism, hyperprolactinemia, and hypogonadism are common endocrinopathies in POEMS syndrome. Thyroid function significantly improved regardless of the initial regimens. Thyroid function parallels with baseline risk stratification, and patients with baseline hypothyroidism have significantly inferior OS and PFS.
Collapse
Affiliation(s)
- Hongbo Yang
- Department of Endocrinology, Key laboratory of Endocrinology of National Health Commission, The Translational Medicine Center of PUMCH, Beijing, China
| | - Hao Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuemin Gao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xufei Huang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinxin Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weibo Xia
- Department of Endocrinology, Key laboratory of Endocrinology of National Health Commission, The Translational Medicine Center of PUMCH, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jian Li
| |
Collapse
|