Clinical Sciences/Health Conditions
Aden Feustel, MD
Resident
Department of Rehabilitation Medicine, University of Washington
Seattle, Washington, United States
Hanna Hunter, MD
Assistant Professor
Department of Rehabilitation Medicine, University of Washington
Seattle, Washington, United States
POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes) syndrome is best understood by two mandatory criteria: a demyelinating/axonal polyneuropathy and a monoclonal plasma cell-proliferative disorder. Autologous stem cell transplantation (ASCT), the recommended treatment, can result in additional mobility impairments such as deconditioning, sarcopenia, and fatigue. We present two patients who underwent ASCT for POEMS syndrome.
Case Description:
Patient A, a 49-year-old man with a plasma cell neoplasm, presented to clinic with lower extremity neuropathy and bilateral foot drop, needing a cane to ambulate. EMG demonstrated severe axonal neuropathy, while nerve ultrasound demonstrated diffuse nerve hypertrophy. One month after ASCT, he had ceased to use tramadol. Follow-up EMG showed regenerating MUAPs in his legs. He had improved ambulation with ankle/foot orthoses and walking sticks.
Patient B, a 62-year-old man with multiple myeloma, presented to clinic with neuropathy and hip pain due to a lytic femur lesion. He ambulated with a cane with Trendelenburg gait but progressed to wheelchair use prior to ASCT due to pain. Rehabilitation Medicine visits were focused on safe mobility counseling and compensatory strategies for ADLs. After ASCT, he used less oxycodone and walked several miles daily without an assistive device.
Discussions:
Our findings are concordant with a large cohort study of patients who underwent ASCT for POEMS syndrome, which showed an 18-point improvement on the Neuropathy Impairment Score at 12 months and improvement on the modified Rankin Scale from 3 to 2. Although peri-engraftment syndrome is a common complication of ASCT, neither of our patients experienced this.
Conclusions:
POEMS syndrome has a significant impact on the quality of life of affected individuals and leads to progressive deterioration unless treated. ASCT may lead to meaningful improvement in neuropathy symptoms. Rehabilitation services are essential through the diagnostic and transplant process to address rapidly evolving functional impairments and support recovery in long-term survivorship.
