POEMS syndrome natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]Sabawoon Mirwais, M.B.B.S, M.D.[3]
Overview
POEMS syndrome presents as a chronic progressive polyneuropathy. Patients may have coexisting multi-organ system disorders. The neuropathy is usually symmetrical and ascending. Endocrinopathy, present in majority of cases, involves hypogonadism, hypothyroidism, and abnormalities of the pituitary-adrenal axis. If left untreated, patients suffering from POEMS syndrome may become wheel chair bound. Complications of POEMS syndrome include renal failure, pulmonary hypertension, pathologic fractures, ischemic stroke, restrictive lung disease, polycythemia, thrombocytosis, papilledema, and myocardial infarction. 3, 5, and 10 year overall survival (OS) for patients newly diagnosed with POEMS syndrome is 87.7%, 84.1%, and 77%. Age >50 years, pulmonary hypertension, pleural effusion, and estimated glomerular filtration rate <30 ml/min/1.73 m2 were associated with inferior overall survival in the derivation cohort, with the use of multivariate Cox regression model based on randomized sample splitting of 362 patients. Low albumin (defined as<3.2 g/dl) at diagnosis and failure to achieve a complete hematologic response to first-line therapy can be independent risk factors for progression-free survival (PFS). Improvement of plasma cell dyscrasia leads to improvement or marked reduction in other abnormalities. Neuropathy, stroke, and myocardial infarction are the most common causes of death in POEMS syndrome.
Natural History
- POEMS syndrome typically presents as a chronic progressive polyneuropathy with both sensory and motor disability, the motor component is usually present to a greater degree than the sensory component of the disease.[1]
- Many patients may have coexisting multi-organ system disorders such as organomegaly (liver, spleen and lymph nodes), edema, endocrinopathy (pituitary, thyroid, adrenal glands), thrombocytosis, polycythemia, pulmonary hypertension, an M-spike (M protein or para-protein, may be IgA lambda component, IgG lambda component or light chain lambda component) and skin changes. The skin changes include angiomata, hyperpigmentation, hypertrichosis.[2]
- The neuropathy is usually symmetrical and ascending, with either insidious or rapidly progressing onset. Sensory neuropathy precedes motor dysfunction and pin-prick and vibratory sensations are typically affected.
- The endocrinopathy is present in a majority of cases of POEMS syndrome. Almost all patients exhibiting endocrinopathy have hyperestrogenemia. The increased levels of estrogen may be the cause of hypogonadism and impotence seen in male patients. Hypogonadism, hypothyroidism, and abnormalities of the pituitary-adrenal axis are noted in order of descending frequency.[3][4]
- POEMS syndrome may also lead to glomerular disease (membranoproliferative glomerulonephritis) eventually resulting in renal failure.
- If left untreated, patients suffering from POEMS syndrome may become wheel chair bound.
Complications
- Patients suffering from POEMS syndrome may develop the following complications:
Prognosis
- The median survival of patients with POEMS syndrome is 165 months.
- 3, 5, and 10 year overall survival (OS) for patients newly diagnosed with POEMS syndrome is 87.7%, 84.1%, and 77%.[15]
- Age >50 years, pulmonary hypertension, pleural effusion, and estimated glomerular filtration rate <30 ml/min/1.73 m2 were associated with inferior overall survival in the derivation cohort, with the use of multivariate Cox regression model based on randomized sample splitting of 362 patients.[15][16][17][9][18]
- Low albumin (defined as<3.2 g/dl) at diagnosis and failure to achieve a complete hematologic response to first-line therapy can be independent risk factors for progression-free survival (PFS).[15][19]
- Papilledema, decreased diffusing capacity of the lung for carbon monoxide (DLCO) and treatment with corticosteroids alone are also related to poor prognosis.[20]
- Improvement of plasma cell dyscrasia leads to improvement or marked reduction in other abnormalities.
- Neuropathy, stroke and myocardial infarction are the most common causes of death in POEMS syndrome.
References
- ↑ Mauermann ML (February 2018). "The Peripheral Neuropathies of POEMS Syndrome and Castleman Disease". Hematol. Oncol. Clin. North Am. 32 (1): 153–163. doi:10.1016/j.hoc.2017.09.012. PMID 29157616.
- ↑ Dispenzieri A (August 2012). "POEMS syndrome: update on diagnosis, risk-stratification, and management". Am. J. Hematol. 87 (8): 804–14. doi:10.1002/ajh.23288. PMID 22806697.
- ↑ Gandhi GY, Basu R, Dispenzieri A, Basu A, Montori VM, Brennan MD (July 2007). "Endocrinopathy in POEMS syndrome: the Mayo Clinic experience". Mayo Clin. Proc. 82 (7): 836–42. doi:10.4065/82.7.836. PMID 17605964.
- ↑ Caimari F, Keddie S, Lunn MP, D'Sa S, Baldeweg SE (September 2018). "Prevalence and course of endocrinopathy in POEMS syndrome". J. Clin. Endocrinol. Metab. doi:10.1210/jc.2018-01516. PMID 30239770.
- ↑ Modesto-Segonds A, Rey JP, Orfila C, Huchard G, Suc JM (May 1995). "Renal involvement in POEMS syndrome". Clin. Nephrol. 43 (5): 342–5. PMID 7634552.
- ↑ Brewis MJ, Church AC, Peacock AJ, Thomson S, Tighe J, Johnson MK (December 2014). "Pulmonary hypertension in POEMS syndrome: resolution following radiotherapy". Pulm Circ. 4 (4): 732–5. doi:10.1086/678553. PMID 25610609.
- ↑ Shibuya K, Misawa S, Horikoshi T, Kanai K, Isose S, Nasu S, Sekiguchi Y, Noto Y, Fujimaki Y, Nakaseko C, Kuwabara S (2011). "Detection of bone lesions by CT in POEMS syndrome". Intern. Med. 50 (13): 1393–6. PMID 21720058.
- ↑ Fu FW, Rao J, Zheng YY, Wang HL, Yang JG, Zheng GQ (October 2017). "Ischemic stroke in patients with POEMS syndrome: a case report and comprehensive analysis of literature". Oncotarget. 8 (51): 89406–89424. doi:10.18632/oncotarget.20131. PMID 29179528.
- ↑ 9.0 9.1 Allam JS, Kennedy CC, Aksamit TR, Dispenzieri A (April 2008). "Pulmonary manifestations in patients with POEMS syndrome: a retrospective review of 137 patients". Chest. 133 (4): 969–74. doi:10.1378/chest.07-1800. PMID 18198255.
- ↑ Naddaf E, Dispenzieri A, Mandrekar J, Mauermann ML (October 2015). "Thrombocytosis distinguishes POEMS syndrome from chronic inflammatory demyelinating polyneuropathy". Muscle Nerve. 52 (4): 658–9. doi:10.1002/mus.24768. PMID 26179010.
- ↑ Decker P, Galland J, Risse J, Claudin M, Mohamed S, Perrot A, Wahl D (February 2018). "[A POEMS syndrome revealed by a blue toe syndrome]". Rev Med Interne (in French). 39 (2): 127–129. doi:10.1016/j.revmed.2017.09.005. PMID 29288001.
- ↑ Schulz W, Domenico D, Nand S (March 1989). "POEMS syndrome associated with polycythemia vera". Cancer. 63 (6): 1175–8. PMID 2537136.
- ↑ Kumar S, Sharma S (March 2015). "Polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes (POEMS syndrome): a paraneoplastic syndrome". Oxf Med Case Reports. 2015 (3): 237–40. doi:10.1093/omcr/omv023. PMID 26634133.
- ↑ Manning WJ, Goldberger AL, Drews RE, Goldstein BJ, Matheson JK, Rabinowe SL, Trentham DE, Landsberg L (December 1992). "POEMS syndrome with myocardial infarction: observations concerning pathogenesis and review of the literature". Semin. Arthritis Rheum. 22 (3): 151–61. PMID 1295088.
- ↑ 15.0 15.1 15.2 Wang C, Huang XF, Cai QQ, Cao XX, Duan MH, Cai H, Zhou DB, Li J (January 2017). "Prognostic study for overall survival in patients with newly diagnosed POEMS syndrome". Leukemia. 31 (1): 100–106. doi:10.1038/leu.2016.168. PMID 27338259.
- ↑ Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (March 2013). "Frailty in elderly people". Lancet. 381 (9868): 752–62. doi:10.1016/S0140-6736(12)62167-9. PMC 4098658. PMID 23395245.
- ↑ Lesprit P, Godeau B, Authier FJ, Soubrier M, Zuber M, Larroche C, Viard JP, Wechsler B, Gherardi R (March 1998). "Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines". Am. J. Respir. Crit. Care Med. 157 (3 Pt 1): 907–11. doi:10.1164/ajrccm.157.3.9707095. PMID 9517610.
- ↑ Li J, Tian Z, Zheng HY, Zhang W, Duan MH, Liu YT, Cao XX, Zhou DB (March 2013). "Pulmonary hypertension in POEMS syndrome". Haematologica. 98 (3): 393–8. doi:10.3324/haematol.2012.073031. PMC 3659947. PMID 22983590.
- ↑ Kourelis TV, Buadi FK, Gertz MA, Lacy MQ, Kumar SK, Kapoor P, Go RS, Lust JA, Hayman SR, Rajkumar V, Zeldenrust SR, Russell SJ, Dingli D, Lin Y, Leung N, Hwa YL, Gonsalves W, Kyle RA, Dispenzieri A (May 2016). "Risk factors for and outcomes of patients with POEMS syndrome who experience progression after first-line treatment". Leukemia. 30 (5): 1079–85. doi:10.1038/leu.2015.344. PMID 26669974.
- ↑ Cui R, Yu S, Huang X, Zhang J, Tian C, Pu C (January 2014). "Papilloedema is an independent prognostic factor for POEMS syndrome". J. Neurol. 261 (1): 60–5. doi:10.1007/s00415-013-7143-4. PMID 24141729.