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POEMS syndrome is a rare multisystem disease characterised by polyneuropathy (P), organomegaly (O), endocrinopathy (E), monoclonal gammopathy (M) and skin changes (S).1 A usually severe demyelinating and axonal neuropathy is often the most prominent and disabling clinical manifestation.2 The pathogenesis of POEMS syndrome is unclear even if overproduction of vascular endothelial growth factor (VEGF) seems to play a major role.1 2 Autologous haematopoietic stem cell transplantation (HSCT) is now considered the most effective therapy in patients with disseminated disease.1 This therapy is however not feasible in all patients because of their advanced age or the presence of severe concomitant conditions. A number of immune or cytostatic agents have been also used with variable efficacy in POEMS syndrome,1 including lenalidomide whose efficacy we recently reported in 13 of the 18 treated patients.3 Little is known however on the degree of response to lenalidomide in comparison with HSCT.
We retrospectively reviewed the clinical, biological and electrophysiological data from 15 patients with POEMS syndrome diagnosed according the criteria proposed by Dispenzieri,1 who neurologically improved after therapy with lenalidomide or HSCT. All the patients had been treated and followed at our institution for at least 2 years. The study was approved by the institutional review board of our institute, and all the patients signed an informed consent for the review of their data.
Six patients (four males, two females; mean age at disease onset 48 years, range 41–53; …
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