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[POEMS综合征的诊断与管理]

[Diagnosis and management of POEMS syndrome].

作者信息

Ohwada Chikako

机构信息

Department of Hematology, International University of Health and Welfare.

出版信息

Rinsho Ketsueki. 2024;65(9):1033-1041. doi: 10.11406/rinketsu.65.1033.

Abstract

POEMS syndrome is a plasma cell neoplasm that presents with peripheral neuropathy, organomegaly, fluid retention, skin manifestations, osteosclerotic lesions, and λ-type M-proteinemia. The pathogenesis of POEMS syndrome is poorly understood, as the genetic profile of plasma cells in POEMS syndrome differs from that of myeloma. In most cases, POEMS syndrome is difficult to distinguish from chronic inflammatory demyelinating polyneuropathy (CIDP). Consequently, it is essential not to miss characteristic signs of POEMS syndrome such as M-protein, VEGF, pleural effusion, and osteosclerotic lesions. Novel agents for myeloma, such as thalidomide, lenalidomide, and bortezomib, are effective. For younger patients, these agents followed by autologous transplantation with high-dose melphalan is the standard of care. More relapses are now being reported in results of long-term observation, and treatment strategies for relapsed disease must be established.

摘要

POEMS综合征是一种浆细胞肿瘤,表现为周围神经病变、器官肿大、液体潴留、皮肤表现、骨硬化性病变和λ型M蛋白血症。由于POEMS综合征中浆细胞的基因特征与骨髓瘤不同,其发病机制尚不清楚。在大多数情况下,POEMS综合征很难与慢性炎症性脱髓鞘性多发性神经病(CIDP)区分开来。因此,务必不要遗漏POEMS综合征的特征性体征,如M蛋白、血管内皮生长因子(VEGF)、胸腔积液和骨硬化性病变。用于治疗骨髓瘤的新型药物,如沙利度胺、来那度胺和硼替佐米,是有效的。对于年轻患者,这些药物随后联合大剂量美法仑进行自体移植是标准治疗方案。长期观察结果显示现在有更多复发情况报道,因此必须制定复发性疾病的治疗策略。

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