Advanced POEMS syndrome treated with high-dose melphalan followed by autologous blood stem cell transplantation: a single-center experience.
BACKGROUND
POEMS syndrome is a rare paraneoplastic syndrome associated with plasma cell dyscrasia. High-dose chemotherapy followed by autologous stem cell transplantation has shown encouraging efficacy in the treatment of patients with POEMS syndrome. However, there are minimal reports on clinical outcomes after autologous stem cell transplantation for patients with advanced disease and very poor performance status.


METHODS
We retrospectively evaluated 9 advanced POEMS syndrome patients, who had an Eastern Cooperative Oncology Group performance status score of 3 or 4, and were treated with high-dose melphalan therapy followed by autologous stem cell transplantation from 2004 to 2011.


RESULTS
Eight patients achieved initial hematologic response, 4 of whom had complete responses. At a median follow-up of 44 months (range, 8-94 months), 7 patients were alive, with 3-year overall survival rate of 77.8%. There were no hematologic relapses in the survivors. One patient died of disease progression; the other died of pneumonia despite a hematologic response 3 months after autologous stem cell transplantation. All survivors achieved improvement in general performance status and in clinical response.


CONCLUSIONS
High-dose melphalan followed by autologous stem cell transplantation can be considered a valid treatment option even for patients with advanced POEMS syndrome.
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Il-Young
IY
Jang
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Dok Hyun
DH
Yoon
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Shin
S
Kim
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kyoungmin
K
Lee
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kwang-Kuk
KK
Kim
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Young-Min
YM
Lim
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Won-Ki
WK
Min
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cheolwon
C
Suh
Chemotherapy; Illness index; POEMS syndrome; Severity; Stem cell transplantation