A 36-year-old man was admitted because of
numbness and
muscle weakness in the lower extremities. He had gait disturbance, malaise, and
body weight loss. Based on the existence of
monoclonal gammopathy, the proliferation of abnormal plasma cells in the bone marrow, the presence of sclerotic bone lesion,
polycythemia, mild
splenomegaly, and an elevated level of serum
vascular endothelial growth factor (
VEGF) (14,900 pg/mL; normal, 62-707), he was diagnosed as having
peripheral neuropathy, organomegaly, endocrinopathy,
monoclonal gammopathy, and skin changes (
POEMS) syndrome. Following 2 courses of conventional
chemotherapy with
doxorubicin and
dexamethasone, peripheral blood stem cells were mobilized by high-dose
etoposide (500 mg/m(2) x 3 days) and
granulocyte colony-stimulating factor. After purging by CD34+ selection using the CliniMACS device, the selected cells (12.4 x 10(6)/kg) were cryopreserved. He was then treated with tandem high-dose
chemotherapy (HDC) (
melphalan 100 mg/m(2) x 2 days) with autologous stem cell rescue. After the first course of HDC, the serum level of
VEGF normalized and the
minimal residual disease in the bone marrow was reduced below the detection limit of CDR3 analysis by polymerase chain reaction. The patient has been in remission for more than 20 months. He has gradually recovered from the neurological symptoms and now has no impairments of daily living. Our experience suggests that autologous purged
stem cell transplantation should be considered as the treatment of choice for
POEMS syndrome.