title: [POEMS syndrome presenting with transient immunoglobulin isotype switching after successful treatment with autologous peripheral blood stem cell transplantation].
abstract: A 60-year-old man was admitted with muscle weakness and numbness in the extremities. Based on the existence of monoclonal gammopathy of the IgG-lamda type, a slight increase of plasma cells in the bone marrow, and an elevated level of serum vascular endothelial growth factor (VEGF), the diagnosis of POEMS syndrome was made. After peripheral blood stem cell collection by etoposide and G-CSF, the patient received high dose melphalan (200 mg/m2) therapy supported by autologous peripheral blood stem cell transplantation (autoPBSCT). After high-dose chemotherapy with autoPBSCT, the serum VEGF level normalized and the monoclonal IgG-lamda, disappeared. The patient gradually recovered from a bedridden state and at the time of writing has no impairment in his activities of daily life. After the autoPBSCT, monoclonal IgG-kappa, protein was detected transiently in serum. The new monoclonal immunoglobulin was considered to be due to normal immune reconstitution after myeloablation rather than alteration of the abnormal plasma cell clone, similarly as oligoclonal immunoglobulins occur in multiple myeloma after autoPBSCT. AutoPBSCT with high-dose chemotherapy should be considered among the treatments of choice for POEMS syndrome.
authors.affiliation: Division of Hematology, Saitama Medical University.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Sato
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Tomoya
authors.initials: T
authors.lastname: Maeda
authors.forename: Naoki
authors.initials: N
authors.lastname: Takahashi
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Kawai
authors.forename: Itsuro
authors.initials: I
authors.lastname: Jinnai
authors.forename: Masami
authors.initials: M
authors.lastname: Bessho
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kinoshita
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007145:Immunoglobulin kappa-Chains / Q000097:blood; D008297:Male; D008875:Middle Aged; D016878:POEMS Syndrome / Q000276:immunology* / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D014182:Transplantation, Autologous
chemical_list: D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains