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In this issue, Kuwabara et al.1 report on the use of high-dose melphalan and autologous peripheral blood stem cell transplantation (auto-PBSCT, four patients) and high-dose melphalan only (eight patients) in treatment of POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) syndrome, typical features of which are illustrated in the figure. As reported previously2,3 and again here, POEMS is associated with markedly increased serum levels of vascular endothelial growth factor (VEGF), an increase attributed to the underlying plasma proliferative disorder, because the serum level of this cytokine decreases with ablation or irradiation of the osteosclerotic myeloma. Such increases of VEGF are not found in acute or chronic inflammatory demyelinating polyneuropathy other neurologic disorders,3 monoclonal gammopathy of undetermined significance,4,5 or multiple myeloma.5 In the currently reported cases, with auto-PBSCT treatment, the symptoms of POEMS improved, and the serum VEGF levels decreased dramatically to normal or near-normal levels. By contrast, with low-dose melphalan therapy, the effects were not as large, were …
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