Baseline characteristics, interpretation, and resolution for patient case
| Characteristics . | At diagnosis . | Comment . | After therapy . |
|---|---|---|---|
| Demyelinating PN | Classic for POEMS syndrome | Walks with AFOs; still foot drop | |
| Nausea, vomiting, anorexia | Due to adrenal insufficiency | Promptly resolved | |
| Hb, g/dL | 8.6 | Due to adrenal insufficiency, hypothyroidism and chronic disease; unusual to have cytopenias in POEMS | Normalized |
| Platelets, ×109/L | 109 | ||
| Albumin, g/dL | 2.3 | ||
| Creatinine, g/dL | 2.3 | Hypovolemia, diuretic use | |
| M spike | IgA λ | IFE positive | IFE positive |
| IgA, mg/dL | 536 | Elevated | Normal range |
| κ-FLC, mg/dL | 8.26 | Acute renal insufficiency and POEMS syndrome: polyclonal FLC elevation common. | |
| λ FLC, mg/dL | 13.2 | ||
| FLC ratio | 0.626 | ||
| TSH/T4, IU/L, ng/dL | 9.5/0.4 | Hypothyroidism | Replaced |
| Cortisol | 3.3 | Hypoadrenalism | |
| Plasma VEGF, pg/mL | 320 | ULN 86 pg/mL: consistent with POEMS | Normalized |
| IL-6, pg/mL | 62.9 | Bed sores due to chronic debility | |
| Urine 24-h protein, mg | 381 | AKI versus POEMS | |
| BMPC, % | 10 (λ) | On the high side for POEMS syndrome | <5%, but still clonal |
| RVSP, mmHg | 64 | Moderate pulmonary hypertension | Normalized |
| DLCO | Normal | Normal | |
| CT skeletal survey | Bones negative, but ascites, effusions, anasarca | >85% patients with bone lesions | Resolved |
| ECOG PS | 4 | 0-1 |
| Characteristics . | At diagnosis . | Comment . | After therapy . |
|---|---|---|---|
| Demyelinating PN | Classic for POEMS syndrome | Walks with AFOs; still foot drop | |
| Nausea, vomiting, anorexia | Due to adrenal insufficiency | Promptly resolved | |
| Hb, g/dL | 8.6 | Due to adrenal insufficiency, hypothyroidism and chronic disease; unusual to have cytopenias in POEMS | Normalized |
| Platelets, ×109/L | 109 | ||
| Albumin, g/dL | 2.3 | ||
| Creatinine, g/dL | 2.3 | Hypovolemia, diuretic use | |
| M spike | IgA λ | IFE positive | IFE positive |
| IgA, mg/dL | 536 | Elevated | Normal range |
| κ-FLC, mg/dL | 8.26 | Acute renal insufficiency and POEMS syndrome: polyclonal FLC elevation common. | |
| λ FLC, mg/dL | 13.2 | ||
| FLC ratio | 0.626 | ||
| TSH/T4, IU/L, ng/dL | 9.5/0.4 | Hypothyroidism | Replaced |
| Cortisol | 3.3 | Hypoadrenalism | |
| Plasma VEGF, pg/mL | 320 | ULN 86 pg/mL: consistent with POEMS | Normalized |
| IL-6, pg/mL | 62.9 | Bed sores due to chronic debility | |
| Urine 24-h protein, mg | 381 | AKI versus POEMS | |
| BMPC, % | 10 (λ) | On the high side for POEMS syndrome | <5%, but still clonal |
| RVSP, mmHg | 64 | Moderate pulmonary hypertension | Normalized |
| DLCO | Normal | Normal | |
| CT skeletal survey | Bones negative, but ascites, effusions, anasarca | >85% patients with bone lesions | Resolved |
| ECOG PS | 4 | 0-1 |
AFOs, ankle foot orthotics; AKI, acute kidney injury; BMPC, bone marrow plasma cells; CT, computed tomography; DLCO, diffusion capacity of carbon monoxide; ECOG, Eastern Cooperative Oncology Group; FLC, immunoglobulin free light chains; Hb, hemoglobin; IFE, immunofixation; IgA, immunoglobulin A; IL-6, interleukin-6; POEMS, polyradiculoneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes; PN, peripheral neuropathy; PS, performance status; RVSP, right ventricular systolic pressure; T4, thyroxine; TSH, thyrotropin; ULN, upper limit of normal; VEGF, vascular endothelial growth factor.