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Ngamdu KS, Torabi A, Badri N, Teleb M, Gaur S. Diffuse large B-cell non-Hodgkin's lymphoma and osteosclerotic myeloma with features of POEMS syndrome. Proc AMIA Symp 2016; 29:306-8. [PMID: 27365880 DOI: 10.1080/08998280.2016.11929446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Multiple myeloma is a clonal hematopoietic neoplasm characterized by the proliferation of malignant plasma cells and associated end-organ damage, most notably lytic lesions in the bones. Osteosclerotic myeloma is an unusual variant of the disease in which the skeletal involvement is characterized by sclerotic lesions instead of classical lytic lesions. The disease can be associated with paraneoplastic symptoms, which have been given the acronym POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes). In addition to clonal plasma cell dyscrasias, some cases of POEMS syndrome are associated with Castleman's disease, and in 11% to 30% of the cases both Castleman's disease and clonal plasma cell proliferation are present. POEMS syndrome has rarely been described in patients with non-Hodgkin's lymphoma.
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Affiliation(s)
- Kyari Sumayin Ngamdu
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas (Ngamdu, Torabi, Badri, Teleb, Gaur); and the Departments of Internal Medicine (Ngamdu, Badri, Teleb, Gaur), Pathology (Torabi), and Hematology/Oncology (Gaur), University Medical Center, El Paso, Texas
| | - Alireza Torabi
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas (Ngamdu, Torabi, Badri, Teleb, Gaur); and the Departments of Internal Medicine (Ngamdu, Badri, Teleb, Gaur), Pathology (Torabi), and Hematology/Oncology (Gaur), University Medical Center, El Paso, Texas
| | - Nabeel Badri
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas (Ngamdu, Torabi, Badri, Teleb, Gaur); and the Departments of Internal Medicine (Ngamdu, Badri, Teleb, Gaur), Pathology (Torabi), and Hematology/Oncology (Gaur), University Medical Center, El Paso, Texas
| | - Mohammed Teleb
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas (Ngamdu, Torabi, Badri, Teleb, Gaur); and the Departments of Internal Medicine (Ngamdu, Badri, Teleb, Gaur), Pathology (Torabi), and Hematology/Oncology (Gaur), University Medical Center, El Paso, Texas
| | - Sumit Gaur
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas (Ngamdu, Torabi, Badri, Teleb, Gaur); and the Departments of Internal Medicine (Ngamdu, Badri, Teleb, Gaur), Pathology (Torabi), and Hematology/Oncology (Gaur), University Medical Center, El Paso, Texas
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Nakayama S, Yokote T, Kobayashi K, Hirata Y, Akioka T, Miyoshi T, Oka S, Hiraoka N, Iwaki K, Takayama A, Takubo T, Tsuji M, Hanafusa T. Primary cutaneous diffuse large B-cell lymphoma, leg type, with features simulating POEMS syndrome. Eur J Haematol 2010; 84:79-83. [PMID: 19558504 DOI: 10.1111/j.1600-0609.2009.01307.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 91-year-old woman presented with a rapidly proliferative cutaneous lesion on the left lower limb, which was identified as a primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, on biopsy. The patient also showed complications of hepatomegaly, endocrinopathy, edema, skin change, and polyneuropathy without monoclonal plasma cell proliferative disorder, and was therefore diagnosed with POEMS-like syndrome owing to the lack of monoclonal plasma cell proliferative disorder. Levels of serum vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) were high with the lymphoma cells immunostained positively for VEGF and IL-6. To the best of our knowledge, this is the first case report of PCLBCL, leg type, with POEMS-like syndrome. The findings in this case suggest that the symptoms of POEMS-like syndrome might be caused by the cytokines produced by the lymphoma cells. Furthermore, a wider range of diagnostic criteria associated with the result of abnormal secretion of cytokine may have to be considered for the diagnosis and evaluation of patients with possible POEMS syndrome, as against the present criteria specifying monoclonal plasma cell proliferative disorder as the essential criterion.
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Affiliation(s)
- Shoko Nakayama
- Department of Internal Medicine, Osaka Medical College, Takatsuki City, Japan.
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Dupont SA, Dispenzieri A, Mauermann ML, Rabinstein AA, Brown RD. Cerebral infarction in POEMS syndrome: incidence, risk factors, and imaging characteristics. Neurology 2009; 73:1308-12. [PMID: 19841383 DOI: 10.1212/wnl.0b013e3181bd136b] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To determine the risk factors and incidence of cerebral infarction associated with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome. METHODS The Mayo Clinic dysproteinemia database was queried to identify patients with coded diagnosis of POEMS syndrome. Patients with cerebral infarction, occurring after the onset of POEMS-related symptoms, were selected. A retrospective observational study design was used to evaluate potential predictors of stroke in patients with POEMS syndrome. RESULTS A total of 9 patients (10%; 95% confidence interval 5.4-17.9) with cerebral infarction were identified (2 women, 22%). Traditional stroke risk factors were not significantly different between the stroke and nonstroke subgroups, but hematologic abnormalities such as elevated platelet count and bone marrow plasmacytosis differed between the 2 groups. Cerebral infarction occurrence after successful treatment of the underlying condition was not observed. CT and MRI data demonstrated a wide spectrum of infarct topography in these patients. Common stroke etiologies comprised suspected vascular structural abnormalities leading to vessel dissection and stenosis, in addition to embolism from a proximal source. CONCLUSIONS The 5-year risk of cerebral infarction in patients with POEMS syndrome is 13.4%. Evidence of plasma cell proliferation within the bone marrow and elevated serum platelet count led to increased risk of cerebral infarction in this population. We conclude that known modifiable stroke risk factors should be aggressively managed. Treatment of thrombocytosis should be considered in patients without a contraindication. Treatment of the syndrome may be the best approach to decreasing risk of cerebral infarction in these patients.
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Affiliation(s)
- S A Dupont
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
POEMS syndrome is a rare paraneoplastic syndrome secondary to a plasma cell dyscrasia. Recognition of the complex of a combination of peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder, skin changes, papilledema, extravascular volume overload (peripheral edema, pleural effusions, ascites), sclerotic bone lesions, thrombocytosis, Castleman disease is the first step in effectively managing the disease. A rise in the blood levels of vascular endothelial growth factor is usually confirmatory. More than 95% of patients will have monoclonal lambda sclerotic plasmacytoma(s) or bone marrow infiltration. In patients with a dominant sclerotic plasmacytoma, first line therapy should include radiation to the lesion. Retrospective analysis and personal experience would dictate that systemic therapy be considered for patients with diffuse sclerotic lesions or absence of any bone lesion and for those who have not demonstrated stabilization of their disease 3 to 6 months after completing radiation therapy. For those patients with diffuse disease, systemic therapy is indicated. Useful approaches include therapy with corticosteroids, low dose alkylator therapy, and high dose chemotherapy with peripheral blood stem cell transplant. Until the pathogenesis is fully understood, these are the mainstays of treatment for patients with POEMS syndrome. The role of anti-VEGF therapies, immune modulatory drugs, and proteasome inhibitors has not yet been defined, but drugs with known high rates of treatment related neuropathy should not be considered as first line therapy.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, United States.
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Dispenzieri A, Kyle RA, Lacy MQ, Rajkumar SV, Therneau TM, Larson DR, Greipp PR, Witzig TE, Basu R, Suarez GA, Fonseca R, Lust JA, Gertz MA. POEMS syndrome: definitions and long-term outcome. Blood 2003; 101:2496-506. [PMID: 12456500 DOI: 10.1182/blood-2002-07-2299] [Citation(s) in RCA: 472] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The POEMS syndrome (coined to refer to polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) remains poorly understood. Ambiguity exists over the features necessary to establish the diagnosis, treatment efficacy, and prognosis. We identified 99 patients with POEMS syndrome. Minimal criteria were a sensorimotor peripheral neuropathy and evidence of a monoclonal plasmaproliferative disorder. To distinguish POEMS from neuropathy associated with monoclonal gammopathy of undetermined significance, additional criteria were included: a bone lesion, Castleman disease, organomegaly (or lymphadenopathy), endocrinopathy, edema (peripheral edema, ascites, or effusions), and skin changes. The median age at presentation was 51 years; 63% were men. Median survival was 165 months. With the exception of fingernail clubbing (P =.03) and extravascular volume overload (P =.04), no presenting feature, including the number of presenting features, was predictive of survival. Response to therapy (P <.001) was predictive of survival. Pulmonary hypertension, renal failure, thrombotic events, and congestive heart failure were observed and appear to be part of the syndrome. In 18 patients (18%), new disease manifestations developed over time. More than 50% of patients had a response to radiation, and 22% to 50% had responses to prednisone and a combination of melphalan and prednisone, respectively. We conclude that the median survival of patients with POEMS syndrome is 165 months, independent of the number of syndrome features, bone lesions, or plasma cells at diagnosis. Additional features of the syndrome often develop, but the complications of classic multiple myeloma rarely develop.
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Affiliation(s)
- Angela Dispenzieri
- Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
Paraprotein-associated neuropathies are a diverse group of disorders. The pathogenesis of many of them is poorly understood. Treatments have usually consisted of plasma exchange, corticosteroids, intravenous immunoglobulin, and other immunosuppressive therapies. Response to treatment has varied from good to very poor. Most recent work in this field has had two goals: achieving a better understanding of pathogenesis and developing better treatments. Such diverse entities as hepatitis C virus, vascular endothelial growth factor, and cytokines now appear to play a role in pathogenesis. More aggressive therapies such a bone marrow transplantation, interferon-alpha, and Rituximab have shown some promise.
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Affiliation(s)
- Z Simmons
- Division of Neurology, Penn State University College of Medicine, M.S. Hershey Medical Center, Hershey 17033, USA.
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