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=38) or G-CSF alone (n=18). The median total number of harvested CD34+ cells was 2.01 × 10(6)/kg (range, 0.18-9.0 × 10(6)/kg). In all, 29 (51.8%) patients failed to yield more than 2 × 10(6)/kg CD34+ cells, and among them, 7 (12.5%) patients yielded <1 × 10(6)/kg CD34+ 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+ cells and high morbidity. Induction therapy before mobilization might improve the efficacy and safety of mobilization.