PBSC mobilization in newly diagnosed patients with POEMS syndrome: outcomes and prognostic factors

Abstract

Autologous PBSC transplantation is a preferred treatment for patients with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS syndrome). However, data on stem cell mobilization in POEMS syndrome are limited. We retrospectively reviewed outcomes and factors prognostic of mobilization in newly diagnosed patients with POEMS syndrome. A total of 56 patients (41 men and 15 women) were included and the median age was 45 years (range, 24-62). All patients underwent mobilization with CY plus granulocyte CSF (G-CSF) (n ¼ 38) or G-CSF alone (n ¼ 18). The median total number of harvested CD34 þ cells was 2.01 Â 10 6 /kg (range, 0.18-9.0 Â 10 6 /kg). In all, 29 (51.8%) patients failed to yield more than 2 Â 10 6 /kg CD34 þ cells, and among them, 7 (12.5%) patients yielded o1 Â 10 6 /kg CD34 þ cells. The overall mobilization-related morbidity was 23.3% and acute renal failure was the most common complication during mobilization. Multivariate analysis showed that hepatomegaly (odds ratio 0.06, 95% confidence interval (CI) 0.01-0.43) and mobilization regimen of G-CSF alone (odds ratio 0.08, 95% CI 0.01-0.70) were independent prognostic factors for successful mobilization in POEMS syndrome. In conclusion, mobilization in newly diagnosed patients with POEMS syndrome is challenging with low yield of CD34 þ cells and high morbidity. Induction therapy before mobilization might improve the efficacy and safety of mobilization.

Durable responses with autologous hematopoietic SCT in patients with POEMS syndrome

“…This is consistent with data from Mayo clinic 8 , but contrary to some reports which documented poor mobilization in these patients 15, 16 . With small numbers and a heterogeneous population, it is difficult to comment on the causes of this discrepancy.…”

Prognostic study for overall survival in patients with newly diagnosed POEMS syndrome

“…The accepted explanation is that absolute level of VEGF does not correlate with disease activity well [2]. In contrast, clinical variables, as the consequence of VEGF elevation, could mark disease severity [31,32].…”

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes (Crow–Fukase) syndrome: Diagnostic criteria and treatment perspectives

“…Induction or maintenance therapy using iMiD or proteasome inhibitor is commonly used in multiple myeloma . In addition, the possibility of poor stem cell mobilization in POEMS syndrome was pointed out . Induction therapy might contribute to both long‐term remission and stem cell mobilization.…”

“…48,49 In addition, the possibility of poor stem cell mobilization in POEMS syndrome was pointed out. 50 Induction therapy might contribute to both long-term remission and stem cell mobilization. Plerixafor, an antagonist of CXCR4, could also be useful for poor mobilizers.…”