POEMS syndrome is a rare plasma cell disorder, characterized by
polyneuropathy, organomegaly, endocrinopathy, serum monoclonal
protein, and skin lesions. Although not included in the acronym, renal lesions also are characteristic of this disease and sometimes require dialysis
therapy. We treated a 61-year-old woman with
POEMS syndrome with high-dose
melphalan therapy (HDT) supported by autologous blood
stem cell transplantation (SCT), and clinical remission was achieved. A repeated renal biopsy showed the striking effectiveness of this
therapy on renal lesions. Pathological features of the renal lesions, such as
membranoproliferative glomerulonephritis-like lesions, microangiopathic glomerulopathy, and mesangiolytic lesions with microcapillaries, almost completely disappeared. This treatment also markedly decreased serum levels of
vascular endothelial growth factor (
VEGF). These findings indicate that HDT with SCT is effective, even on renal lesions in patients with
POEMS syndrome, and suggest that high serum
VEGF concentrations are associated closely with the development of renal lesions in patients with this type of plasma cell disorder.