Summary:POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a plasma cell dyscrasia that differs substantially from classic multiple myeloma. It is often associated with disabling polyneuropathy in younger patients. Current therapeutic approaches are frequently inadequate and leave many patients wheelchair-bound with significant deterioration in quality and length of life. We present the case of a young man with progressive disease despite conventional therapeutic approaches. We describe a novel approach to treatment with a boneseeking radiopharmaceutical, samarium-153 ethylene diamine tetramethylene phosphonate ( 153 Sm-EDTMP), followed by myeloablative chemotherapy with autologous hematopoietic progenitor cell reconstitution. This approach resulted in regression of the organomegaly and skin changes and in neurologic improvement both clinically and electrophysiologically. The patient progressed from being wheelchair-bound to independent ambulation. An aggressive approach should be considered in patients with POEMS syndrome in whom standard therapeutic measures fail. Bone Marrow Transplantation (2001) 28, 305-309. Keywords: POEMS syndrome; autologous hematopoietic stem cell transplantation; samarium-153 EDTMP The association between polyneuropathy and monoclonal proteins has been recognized for many years. The acronym POEMS was coined by Bardwick et al 1 to describe a syndrome of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. This syndrome occurs more frequently in Japan, where it is commonly known as Crow-Fukase syndrome.2 In a recent review at the Mayo Clinic, only 20 of 93 patients had the complete pentad. A constellation of additional features has been described, including fever, peripheral edema (29%), ascites (11%), pleural effusion, polycythemia, pulmonary hyper-
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