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NDT Plus Advance Access originally published online on July 22, 2009
NDT Plus 2009 2(5):357-359; doi:10.1093/ndtplus/sfp094
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS) syndrome refractory to complete serum vascular endothelial growth factor (VEGF) blockade: insights from sequential VEGF monitoring

Joëlle Guitard1, Adèle Pillet1, Martin Soubrier2, Anne Modesto3 and Dominique Chauveau1,4

1 Department of Nephrology and Clinical Immunology, University Hospital Rangueil, Toulouse
2 Department of Rheumatology and Clinical Immunology, University Hospital Gabriel Montpied, Clermont-Ferrand
3 Department of Histopathology, University Hospital Rangueil
4 Unité INSERM U 563, University Hospital Purpan, Toulouse, France

Correspondence: Correspondence and offprint requests to: Joëlle Guitard; E-mail: guitard.joelle{at}chu-toulouse.fr


  Abstract

Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes (POEMS) syndrome is a systemic condition related to plasma cell dyscrasia. Increased vascular permeability is responsible for some of the hallmarks of this disorder that may include renal microangiopathy. Several lines of evidence suggest that vascular endothelial growth factor (VEGF) is central to the pathogenesis of POEMS syndrome. Thus, specifically targeting VEGF over-expression seems to be a promising treatment. Anti-VEGF therapies are yielding conflicting results. We report on a patient with POEMS syndrome treated with bevacizumab, an anti-VEGF monoclonal antibody. Sequential monitoring of serum VEGF showed sustained normalization of serum VEGF levels, without any beneficial effect on the patient's condition. Indications of this treatment should be chosen carefully.

Key Words: bevacizumab • microangiopathy • polyneuropathy organomegaly endocrinopathy monoclonal protein • skin changes syndrome • vascular endothelial growth factor

Received for publication June 29, 2009. Accepted for publication June 30, 2009.


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