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Successful second autologous stem-cell transplantation for patients with relapsed and refractory POEMS syndrome

Bone Marrow Transplantation volume 56, pages 517–520 (2021)Cite this article

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POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a paraneoplastic disorder secondary to plasma cell dyscrasias [1]. Although high-dose melphalan followed by autologous peripheral blood stem-cell transplantation (ASCT) has been reported to improve the prognosis, there is no standard strategy for relapse after ASCT [1]. Here, we report a case series of four patients with relapsed POEMS syndrome who were successfully treated by a second ASCT.

Between January 2011 and June 2016, four patients underwent a second ASCT at Chiba University Hospital. The details are presented in Table 1. Hematological response (CRH) was defined as a negative immunofixation of the serum or urine. As monoclonal protein values were small, patients were categorized only into CRH vs. no CRH (NRH). Vascular endothelial growth factor (VEGF) response was defined as; complete response (CRv): normalized VEGF, partial response (PRv): reduction of VEGF levels by at least 50% of the baseline. Clinical response was defined as an improvement of any features attributable to POEMS syndrome. Before the first ASCT, two patients received induction therapy with antimyeloma agents such as thalidomide (Td), lenalidomide (Rd), or bortezomib (Bd) in combination with dexamethasone. At the time of the first ASCT, none of the patients achieved CRH or CRv. The first ASCT was conditioned by high-dose melphalan in three patients and cyclophosphamide, etoposide, and ranimustine in one. Post first ASCT, CRv was achieved in all the patients; however, CRH was achieved in only one.

Table 1 Patients’ characteristics and procedures of 1st and 2nd ASCT.
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Authors and Affiliations

  1. Department of Hematology, Chiba University Hospital, Chiba, Japan

    Asuka Shibamiya, Chikako Ohwada, Arata Ishii, Tatsuzo Mishina, Yurie Nagai, Yutaro Hino, Kensuke Kayamori, Nagisa Oshima-Hasegawa, Tomoya Muto, Shokichi Tsukamoto, Yusuke Takeda, Tohru Iseki & Emiko Sakaida

  2. Department of Hematology, International University of Health and Welfare School of Medicine, Narita, Japan

    Chikako Ohwada & Chiaki Nakaseko

  3. Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital, Chiba, Japan

    Shio Mitsukawa, Naoya Mimura & Tohru Iseki

  4. Department of Neurology, Chiba University Graduate School of Medicine, Chiba, Japan

    Sonoko Misawa & Satoshi Kuwabara

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  1. Asuka Shibamiya
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Correspondence to Chikako Ohwada.

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Shibamiya, A., Ohwada, C., Ishii, A. et al. Successful second autologous stem-cell transplantation for patients with relapsed and refractory POEMS syndrome. Bone Marrow Transplant 56, 517–520 (2021). https://doi.org/10.1038/s41409-020-01024-9

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