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Discrepancy between disease activity and levels of vascular endothelial growth factor in a patient with POEMS syndrome successfully treated with autologous stem-cell transplantation

Bone Marrow Transplantation volume 42, pages 627–629 (2008)Cite this article

POEMS syndrome is defined by the presence of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. Increasing evidence suggests that an overproduction of vascular endothelial growth factor (VEGF) plays a role in the pathophysiology of POEMS syndrome.1 As VEGF could be a therapeutic target in this disorder, bevacizumab, an anti-VEGF monoclonal antibody has been tried. However, results are contradictory.2, 3, 4, 5, 6 Autologous peripheral blood stem cell transplantation (APBSCT) is another promising therapy for POEMS syndrome and the efficacy of this treatment has been established in the literature.7

A 51-year-old Japanese female presented with slowly progressing distal and symmetrical sensory and motor neuropathy, skin changes and edema in January 2002. Nerve conduction studies were performed but no responses were recordable in either the motor or sensory nerves because of severe edema and skin changes. Laboratory data revealed elevated serum IgG levels that showed a monoclonal lambda component by electrophoresis. In addition, abnormal thyroid function was observed. A CT scan showed bilateral pleural effusions, ascites, splenomegaly and a soft tissue mass over the sacrum. Biopsy of the mass disclosed atypical plasma cells. A skeletal survey was performed with no evidence of any pathological fractures. A diagnosis of POEMS syndrome was made because of the solitary plasmacytoma. On admission, her serum VEGF level was 200 pg/ml (normal <38.3 pg/ml). For measuring VEGF, a 5 ml clotted blood sample was taken on ice, centrifuged at 2000 r.p.m. for 10 min at 4 °C, and a 1.5 ml aliquot of serum was stored at −80 °C until analysis. Immunoreactive VEGF was measured using an ELISA kit (R&D systems, Minneapolis, MN, USA).

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Acknowledgements

We thank Ikumi Sato for her technical support and Brian Quinn for language assistance. This clinical investigation was supported by a grant-in-aid (18591036) from the Ministry of Education, Science, Technology, Sports and Culture of Japan.

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  1. Department of Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    H Goto, M Nishio, K Kumano, K Fujimoto, K Yamaguchi & T Koike

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  1. H Goto
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Correspondence to M Nishio.

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Goto, H., Nishio, M., Kumano, K. et al. Discrepancy between disease activity and levels of vascular endothelial growth factor in a patient with POEMS syndrome successfully treated with autologous stem-cell transplantation. Bone Marrow Transplant 42, 627–629 (2008). https://doi.org/10.1038/bmt.2008.223

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