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Petersen RS, Fijen LM, Franssen LE, Vos JMI, Cohn DM. Daratumumab-based treatment of monoclonal gammopathy-associated angioedema due to acquired C1-inhibitor deficiency. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100322. [PMID: 39282617 PMCID: PMC11393585 DOI: 10.1016/j.jacig.2024.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/29/2024] [Accepted: 05/07/2024] [Indexed: 09/19/2024]
Abstract
Daratumumab-based treatment could control severe, treatment-refractory, life-threatening angioedema due to acquired C1-inhibitor deficiency associated with monoclonal gammopathy.
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Affiliation(s)
- Remy S Petersen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lauré M Fijen
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens E Franssen
- Department of Hematology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Josephine M I Vos
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
- Department of Hematology, Cancer Center Amsterdam and Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Danny M Cohn
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Wang J, Liao W, Liu Z, Kong D. Case report: DKRd regimen in the treatment of newly diagnosed POEMS syndrome and literature review. Front Oncol 2024; 14:1417380. [PMID: 39148901 PMCID: PMC11324492 DOI: 10.3389/fonc.2024.1417380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
POEMS syndrome, characterized as a rare multisystem paraneoplastic syndrome, arises from plasma cell abnormalities. Coined by Bardwick in 1980, the acronym POEMS delineates the distinctive features of the syndrome: Peripheral nerve Lesions, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes. The prevalence of POEMS syndrome stands at approximately 0.3 per 100,000 individuals. Owing to its low prevalence and the paucity of prospective studies, current treatment approaches largely hinge on retrospective studies and revolve around the use of plasma cell-directed therapy typically used in multiple myeloma treatments. This article presents the pioneering case of utilizing a four-drug combination regimen of DKRd (daratumumab, carfilzomib, lenalidomide, and dexamethasone) as a first-line treatment. This is succeeded by induction therapy and subsequently, autologous hematopoietic stem cell transplantation. A comprehensive review of related literature is conducted.
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Affiliation(s)
- Jianchao Wang
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Wensheng Liao
- Department of Surgery of Spine and Spinal Cord, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhongwen Liu
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Dai Kong
- Department of Hematology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
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Boulanger MC, Tieger MG, Eliott D, Yee AJ. Intravitreal aflibercept confounds interpretation of plasma VEGF (vascular endothelial growth factor) levels in POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome. EJHAEM 2024; 5:421-422. [PMID: 38633109 PMCID: PMC11020120 DOI: 10.1002/jha2.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Mary C. Boulanger
- Massachusetts General Hospital Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Marisa G. Tieger
- Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
- Present address:
New England Eye Center, Tufts Medical Center
| | - Dean Eliott
- Harvard Medical SchoolBostonMassachusettsUSA
- Massachusetts Eye and Ear InfirmaryBostonMassachusettsUSA
| | - Andrew J. Yee
- Massachusetts General Hospital Cancer CenterBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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Dispenzieri A. POEMS syndrome: Update on diagnosis, risk-stratification, and management. Am J Hematol 2023; 98:1934-1950. [PMID: 37732822 DOI: 10.1002/ajh.27081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
DISEASE OVERVIEW POEMS syndrome is a life-threatening condition due to an underlying plasma cell neoplasm. The major criteria for the syndrome are polyradiculoneuropathy, clonal plasma cell disorder, sclerotic bone lesions, elevated vascular endothelial growth factor, and the presence of Castleman disease. Minor features include organomegaly, endocrinopathy, characteristic skin changes, papilledema, extravascular volume overload, and thrombocytosis. DIAGNOSIS The diagnosis of POEMS syndrome is made with three of the major criteria, two of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria. RISK STRATIFICATION Because the pathogenesis of the syndrome is not well understood, risk stratification is limited to clinical phenotype rather than specific molecular markers. Risk factors include low serum albumin, age, pleural effusion, pulmonary hypertension, and reduced estimated glomerular filtration rate. RISK-ADAPTED THERAPY For those patients with a dominant plasmacytoma, first-line therapy is irradiation. Patients with diffuse sclerotic lesions or disseminated bone marrow involvement should receive systemic therapy. Corticosteroids are temporizing, but alkylators and lenalidomide are the mainstays of treatment, the former either in the form of low-dose conventional therapy or as high-dose conditioning for stem cell transplantation. Thalidomide and bortezomib also have activity, but their benefit needs to be weighed against their risk of exacerbating the peripheral neuropathy. Daratumumab combinations also appear promising based on case series. Prompt recognition and institution of both supportive care measures and therapy directed against the plasma cell result in the best outcomes.
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Jurczyszyn A, Olszewska-Szopa M, Vesole D. POEMS Syndrome-Clinical Picture and Management. Current Knowledge. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00136-2. [PMID: 37210272 DOI: 10.1016/j.clml.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
POEMS syndrome is a rare form of plasma cell dyscrasia. Difficulties arise already at the stage of making the diagnosis (complex and heterogeneous clinical picture) and continue during the course of treatment (lack of guidelines for therapy, data coming mainly from reports and short series of patients). In this article we review the current state of knowledge on POEMS syndrome diagnostics, clinical characteristics, prognosis, reported treatment outcomes and the emergence of the new therapeutic strategies.
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Affiliation(s)
- Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - David Vesole
- Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ
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Khwaja J, D'Sa S, Lunn MP, Sive J. Evidence-based medical treatment of POEMS syndrome. Br J Haematol 2023; 200:128-136. [PMID: 35934319 DOI: 10.1111/bjh.18400] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 01/14/2023]
Abstract
POEMS syndrome is a rare multisystem paraneoplastic disorder due to an underlying low-level plasma cell dyscrasia. Due to its rarity, there are limited data to guide treatment and there are no consensus guidelines. Therapy choices are dictated by patient characteristics, disease factors and local funding arrangements. The goals of therapy are to eradicate the underlying clone in order to improve quality of life and overall survival. Most evidence has been garnered in the front-line setting. Localised disease responds well to radiotherapy, whilst for those with systemic disease, the best outcomes are demonstrated with induction chemotherapy followed up with high-dose melphalan and stem cell rescue if eligible. For transplant-ineligible patients lenalidomide-dexamethasone remains a preferred treatment option. Data in the relapse setting are scarce. Supportive care including management of neuropathy, endocrinopathy, thrombotic risk and anti-infective agents is necessary. Future international collaboration is crucial to define optimal treatment strategies particularly in the relapse setting.
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Affiliation(s)
- Jahanzaib Khwaja
- Department of Haematology, University College London Hospitals, London, UK
| | - Shirley D'Sa
- Department of Haematology, University College London Hospitals, London, UK
| | - Michael P Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jonathan Sive
- Department of Haematology, University College London Hospitals, London, UK
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Bou Zerdan M, George TI, Bunting ST, Chaulagain CP. Recent Advances in the Treatment and Supportive Care of POEMS Syndrome. J Clin Med 2022; 11:jcm11237011. [PMID: 36498588 PMCID: PMC9741379 DOI: 10.3390/jcm11237011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
POEMS is a rare clonal plasma cell disorder characterized by multi-systemic features that include demyelinating peripheral neuropathy, organomegaly, endocrinopathy, presence of monoclonal proteins (M-protein), and skin changes. Even though the pathophysiology is poorly understood, recent studies suggest that both clonal and polyclonal plasmacytosis leading to the production of pro-inflammatory cytokines and angiogenic mediators play the central role. These mediators including vascular endothelial growth factor (VEGF) are the driving forces of the syndrome. The diagnosis of POEMS is not always straight forward and often the diagnosis is delayed. It is based on fulfilling mandatory criteria of polyradiculoneuropathy and monoclonal protein and the presence of one major criterion (Castleman disease, sclerotic bone lesions, or elevated VEGF), and at least one minor criterion. Due to the presence of neuropathy, it can be confused with chronic inflammatory demyelinating polyradiculopathy (CIDP), and if thrombocytosis and splenomegaly are present, it can be confused with myeloproliferative neoplasms. Due to the rarity of the syndrome, clear guidelines for treatment are still lacking. Immediate treatment targeting the underlying plasma cell proliferation results in a dramatic response in most patients. The key is early diagnosis and immediate anti-plasma cell directed therapy for the best clinical outcomes. For patients with disseminated disease as defined by bone marrow involvement or more than three osteosclerotic bone lesions, high-dose chemotherapy with autologous hematopoietic stem cell transplant (ASCT) yields durable responses and is the preferred treatment in eligible patients. For patients with localized bony disease, radiotherapy has proven to be very effective. Lenalidomide and dexamethasone is a proven therapy in patients ineligible for ASCT. In this review article, we tackle the diagnostic approach and discuss the latest treatment modalities of this rare debilitating disease.
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Affiliation(s)
- Maroun Bou Zerdan
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida 2950, Weston, FL 33331, USA
- Department of Internal Medicine, SUNY Upstate Medical University Hospital, Syracuse, NY 13210, USA
| | - Tracy I. George
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Silvia Tse Bunting
- Division of Hematopathology and Flow Cytometry Laboratory, Department of Pathology, Cleveland Clinic Florida 2950, Weston, FL 33331, USA
| | - Chakra P. Chaulagain
- Department of Hematology-Oncology, Myeloma and Amyloidosis Program, Maroone Cancer Center, Cleveland Clinic Florida 2950, Weston, FL 33331, USA
- Correspondence: ; Tel.: +1-954-659-5840; Fax: +1-954-659-5810
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Taenaka R, Shimokawa S, Katayama A, Nagao T, Obara T, Nishimura N, Tsujimoto A, Kohno K, Aoki K, Ogawa R. Successful treatment with daratumumab, lenalidomide, and dexamethasone therapy followed by autologous stem cell transplantation for newly diagnosed polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome: a case report. J Med Case Rep 2022; 16:311. [PMID: 35978379 PMCID: PMC9387014 DOI: 10.1186/s13256-022-03552-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transplant-eligible patients with polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome are treated with induction therapy and autologous stem cell transplantation. Conventional induction therapies may exacerbate neuropathy and a high rate of disease progression within 5 years. Furthermore, only 50% of patients are able to walk independently after the therapies. Daratumumab, lenalidomide, and dexamethasone therapy has been reported as a less neurotoxic, highly effective therapy for patients with polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome who are ineligible for transplant or whose syndrome is relapsed/refractory, but no reports have provided data from untreated transplant-eligible patients. CASE PRESENTATION A 34-year-old Japanese woman displayed weakness, pain and edema in the lower limbs, decreased grip strength, amenorrhea, and abdominal distention. She was unable to walk independently. The patient was diagnosed with polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome and performed four courses of daratumumab, lenalidomide, and dexamethasone therapy, which enabled her to walk independently and did not exacerbate the neuropathy. Hematopoietic stem cells were collected using plerixafor and filgrastim in combination. Autologous stem cell transplantation was performed with high-dose melphalan. At 3-month post-transplantation follow-up, most of her clinical symptoms had disappeared. CONCLUSIONS Daratumumab, lenalidomide, and dexamethasone therapy followed by autologous stem cell transplantation may be more effective than conventional therapy for newly diagnosed polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes syndrome. Although there was concerns that daratumumab, lenalidomide, and dexamethasone therapy might lead to poor mobilization of hematopoietic stem cells, this was overcome with the combination of plerixafor and filgrastim. The benefit of daratumumab, lenalidomide, and dexamethasone as induction therapy prior to autologous stem cell transplantation should be confirmed in future clinical trials.
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Affiliation(s)
- Ryutaro Taenaka
- Department of Hematology and Oncology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan.
- Department of Medicine and Biosystemic Sciences, Kyushu University Graduate School of Medicine, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, Japan.
| | - Sakurako Shimokawa
- Department of Ophthalmology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Ayako Katayama
- Department of Dermatology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Toshihiko Nagao
- Department of Endocrinology and Metabolism, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Teppei Obara
- Department of Hematology and Oncology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Naoaki Nishimura
- Department of Pharmacy, JCHO Kyushu Hospital, 1-8-1, Kishinoura, Yahatanisi-ku, Kitakyushu, Fukuoka, Japan
| | - Atsushi Tsujimoto
- Department of Neurology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Kentaro Kohno
- Department of Hematology and Oncology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Kenichi Aoki
- Department of Hematology and Oncology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
| | - Ryosuke Ogawa
- Department of Hematology and Oncology, JCHO Kyushu Hospital, 1-8-1 Kishinoura, Yahatanishi-ku, Kitakyushu, Fukuoka, Japan
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Khwaja J, Keh R, Smyth D, Lunn MP, D'Sa S, Sive J. Daratumumab-bortezomib-dexamethasone use in relapsed POEMS syndrome. EJHAEM 2022; 3:1021-1024. [PMID: 36051015 PMCID: PMC9421966 DOI: 10.1002/jha2.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022]
Abstract
POEMS syndrome is a rareparaneoplastic disorder driven by an underlying low level plasma cell dyscrasiaand associated with elevated serum vascular endothelial growth factor (VEGF). Dueto its rarity, there are no internationally agreed standards of care, with verylimited data to guide management in the relapse setting. Agents used in myelomaare rational choices and have been employed. Daratumumab has been reported intwo case studies with lenalidomide-dexamethasone, one in the upfront and one inthe relapsed setting. We are the first to report here three cases ofdaratumumab-bortezomib-dexamethasone (DVd) use in relapsed POEMS postautologous stem cell transplant with good VEGF and clinical responses. Our casesadd to the literature on efficacy of daratumumab and are the first to report onits safe use with bortezomib in relapsed POEMS. It should be considered as aclinical option, in patients not responding to conventional first linetherapies.
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Affiliation(s)
- Jahanzaib Khwaja
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Ryan Keh
- Centre for Neuromuscular DiseaseNational Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
| | - Duncan Smyth
- Centre for Neuromuscular DiseaseNational Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
| | - Michael Peter Lunn
- Centre for Neuromuscular DiseaseNational Hospital for Neurology and Neurosurgery, Queen SquareLondonUK
| | - Shirley D'Sa
- Department of HaematologyUniversity College London HospitalsLondonUK
| | - Jonathan Sive
- Department of HaematologyUniversity College London HospitalsLondonUK
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First-line Usage of Daratumumab, Lenalidomide, Dexamethasone (DRd) Combination in a Case of Castleman Disease Variant of Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Gammopathy, and Skin Changes Syndrome (CD-POEMS). Hemasphere 2022; 6:e728. [PMID: 35747589 PMCID: PMC9208867 DOI: 10.1097/hs9.0000000000000728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/25/2022] [Indexed: 01/14/2023] Open
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Kim YR. Update on the POEMS syndrome. Blood Res 2022; 57:27-31. [PMID: 35483922 PMCID: PMC9057663 DOI: 10.5045/br.2022.2022001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
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.
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Affiliation(s)
- Yu Ri Kim
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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Failure of Daratumumab Therapy for Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Protein, Skin Changes Syndrome. J Clin Neuromuscul Dis 2021; 23:56-58. [PMID: 34431806 DOI: 10.1097/cnd.0000000000000370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khouri J, Nakashima M, Wong S. Update on the Diagnosis and Treatment of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Gammopathy, and Skin Changes) Syndrome: A Review. JAMA Oncol 2021; 7:1383-1391. [PMID: 34081097 DOI: 10.1001/jamaoncol.2021.0586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare plasma cell disorder characterized by demyelinating peripheral neuropathy and clonal plasma cell proliferation. Clinical manifestations are believed to be associated with a surge of inflammatory and angiogenic mediators, including interleukins and vascular endothelial growth factor (VEGF), elicited by clonal and polyclonal plasma cells. The clinical manifestations of POEMS syndrome can be debilitating; therefore, early diagnosis is essential. This review discusses several aspects of POEMS syndrome and includes the most recently published findings, with a special emphasis on diagnosis and treatment strategies. Observations POEMS syndrome may be underdiagnosed because of its rarity, and it can be mistaken for chronic inflammatory demyelinating polyneuropathy; this misdiagnosis may lead to delayed therapy and progressive worsening of symptoms, especially neuropathy. Therefore, in addition to measurement of the VEGF level, patients with a monoclonal protein detected in blood and/or urine and neuropathy should be evaluated for POEMS syndrome with use of imaging to assess whether sclerotic bone lesions, effusions, and organomegaly are present. Clinical trials are scant, and treatment is largely based on small case series in which plasma cell-directed therapies, borrowed from the myeloma armamentarium, were used. High-dose melphalan and autologous hematopoietic cell transplantation may be offered to eligible patients. Lenalidomide and dexamethasone can be prescribed for patients who are ineligible for transplants. The main goals of therapy are to attain complete hematologic and VEGF responses and to reduce symptoms, although it may take up to 3 years for neurologic deficits to be ameliorated. Conclusions and Relevance POEMS syndrome should be considered in the differential diagnosis for patients who have peripheral neuropathy and paraproteinemia among other multisystem manifestations. The syndrome can be debilitating if not recognized early in its course; thus, appropriate diagnosis and treatment are important for optimal clinical outcomes.
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Affiliation(s)
- Jack Khouri
- Department of Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Megan Nakashima
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sandy Wong
- Department of Medicine, University of California, San Francisco, San Francisco
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