1
|
Du HP, Zhang Y, Sun LM, Luo L. Two cases of special POEMS syndrome without monoclonal protein expression: a case report and literature review. J Int Med Res 2021; 49:300060521990967. [PMID: 33820466 PMCID: PMC8033470 DOI: 10.1177/0300060521990967] [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: 11/15/2022] Open
Abstract
POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome is rare, with polyneuropathy and monoclonal plasma cell disorder generally considered as essential diagnostic symptoms. We report two cases of POEMS syndrome without monoclonal protein expression. The first case was a 72-year-old man who had experienced recurrent edema of the lower limbs for 2 years and abdominal distention for 2 months. The other case was a 62-year-old man with a 5-year history of recurrent numbness of the extremities and muscle weakness, which had become serious over the preceding 3 months. Both patients had various symptoms that matched those of POEMS syndrome, but neither had monoclonal protein expression. However, a diagnosis of POEMS syndrome was made in each case. Both patients were treated with lenalidomide and dexamethasone, after which their symptoms improved and laboratory test results normalized. The findings in these two cases suggest the possibility that POEMS syndrome may occur without monoclonal protein expression. The diagnostic criteria of POEMS syndrome may thus need further investigation.
Collapse
Affiliation(s)
- Hua Ping Du
- Hematology Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Ye Zhang
- Hematology Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Lei Min Sun
- Gastrointestinal Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Liang Luo
- Gastrointestinal Department, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
2
|
Zhou X, Wei J, Lou Y, Xu G, Yang M, Liu H, Mao L, Tong H, Jin J. Salvage therapy with lenalidomide containing regimen for relapsed/refractory Castleman disease: a report of three cases. Front Med 2017; 11:287-292. [PMID: 28367597 DOI: 10.1007/s11684-017-0510-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/24/2016] [Indexed: 02/05/2023]
Abstract
Castleman disease (CD) is uncommon non-clonal lymphoproliferative disorder with unknown etiology. No standard therapy is recommended for relapsed/refractory CD patients, thus requiring development of novel experimental approaches. Our cohort of three adult patients with multicentric CD (MCD) were treated with refractory to traditional chemotherapy lenalidomide-containing regimens (10-25 mg lenalidomide perorally administered on days 1-21 in 28-day cycle) as second- to fourth-line treatment. Partial remission was achieved in first plasma-cell CD patient, who relapsed seven months after autologous hematopoietic stem cell transplantation and then failed to respond to four cycles of chemotherapy. Partial remission was obtained in second patient with CD and polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. Third case showed complete remission with complete disappearance of pleural effusion and ascites and normalization of platelet count. To conclude, encouraging clinical responses were achieved in cohort of three patients with lenalidomide-based regimen, though long-term efficacy remains to be observed.We propose further investigation of therapeutic potential of this drug in treating MCD.
Collapse
Affiliation(s)
- Xinping Zhou
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Juying Wei
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Yinjun Lou
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Gaixiang Xu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Min Yang
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Hui Liu
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Liping Mao
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Hongyan Tong
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jie Jin
- Department of Hematology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
| |
Collapse
|
3
|
Yang H, Huang X, Cai Q, Wang C, Cao X, Zhou D, Li J. Improvement of sexual function in POEMS syndrome after combination therapy of Lenalidomide and dexamethasone. Orphanet J Rare Dis 2016; 11:80. [PMID: 27317315 PMCID: PMC4912786 DOI: 10.1186/s13023-016-0461-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 05/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND POEMS syndrome is a rare paraneoplastic syndrome due to an underlying plasma cell neoplasm. Hypogonadism is the most common endocrine abnormality in POEMS syndrome. There is no data about improvement of hypogonadism and sexual dysfunction after appropriate treatment of POEMS syndrome so far. In this single-center prospective study, the efficacy of low-dose lenalidomide and dexamethasone combination therapy in the improvement of sexual and gonadal function in POEMS syndrome was evaluated. RESULTS Thirty-five patients with newly diagnosed POEMS syndrome were treated with Lenalidomide (10 mg daily for 21 days) and dexamethasone (40 mg once per week) for 12 cycles. The international index of erectile function (IIEF) in male patients, the female sexual function index (FSFI) in female patients, total testosterone, estradiol and vascular endothelial growth factor (VEGF) levels were reviewed. Sexual dysfunction was reported in 88.8 % (24/27)male and 90.9 % (10/11) female patients. 62.9 % (17/27) male and 25.0 % (3/12) female patients had hypogonadism. After 12-month treatment, the mean total FSFI score had increased from 17.1 ± 7.2 to 23.7 ± 7.2(p < 0.05). The arousal, orgasm and sex pain domains had been improved significantly. The mean IIEF scores had increased from 12.9 ± 13.0 to 20.5 ± 18.4 (p < 0.05). Erectile function, sexual desire and intercourse satisfaction had improved significantly at the end of treatment. No association between VEGF levels and sexual function improvement was found in both genders. CONCLUSION Combination therapy with low-dose lenalidomide plus dexamethasone is successful in improving sexual function in POEMS syndrome.
Collapse
Affiliation(s)
- Hongbo Yang
- />Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xufei Huang
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qianqian Cai
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Chen Wang
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xinxin Cao
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Daobin Zhou
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jian Li
- />Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| |
Collapse
|
4
|
Yuan M, Chen W, Zhou H, Xiao Z, Wang W, Wang W, Yin X, Xu L. Kennedy Disease Misdiagnosed as Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Gammopathy, and Skin Changes (POEMS) Syndrome: A Case Report. Med Princ Pract 2016; 25:286-9. [PMID: 26618536 PMCID: PMC5588369 DOI: 10.1159/000442822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/29/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of this paper was to report the first case of Kennedy disease misdiagnosed as polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome. CLINICAL PRESENTATION AND INTERVENTION A 58-year-old Chinese man presented with limb numbness, progressive limb proximal weakness, lymph node and thyroid enlargement, edema, pigmentation in the lower limb, and obvious gynecomastia, which was initially diagnosed as POEMS syndrome and was treated with dexamethasone and small doses of cyclophosphamide without any improvement after 6 months. Finally, the patient diagnosis was confirmed as Kennedy disease (KD) by gene analysis. CONCLUSION This case suggests that clinicians should pay more attention to the differential diagnosis between KD and POEMS syndrome. Gene analysis was helpful in detecting this rare confusing disease in this patient.
Collapse
Affiliation(s)
- Min Yuan
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiping Chen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huangyan Zhou
- Department of Immunology and Pathogenic Biology, The Basic Medical College of Nanchang University, Nanchang, China
| | - Zhilong Xiao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Wang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weidong Wang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoping Yin
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Lijun Xu, Department of Neurology, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang 330006 (China), E-Mail
| |
Collapse
|