Multiparameter Flow Cytometry for the Identification of Neoplastic Plasma Cells in POEMS Syndrome with IgG-kappa Gammopathy: Successful Treatment Using Lenalidomide and Dexamethasone

Sho Ikeda; Takahiro Kobayashi; Masaya Saito; Atsushi Komatsuda; Kumi Ubukawa; Yoshihiro Kameoka; Naoto Takahashi

doi:10.2169/internalmedicine.2882-19

CASE REPORTS

Multiparameter Flow Cytometry for the Identification of Neoplastic Plasma Cells in POEMS Syndrome with IgG-kappa Gammopathy: Successful Treatment Using Lenalidomide and Dexamethasone

Sho Ikeda, Takahiro Kobayashi, Masaya Saito, Atsushi Komatsuda, Kumi Ubukawa, Yoshihiro Kameoka, Naoto Takahashi

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Keywords: POEMS syndrome, IgG kappa monoclonal protein, multiparameter flow cytometry, lenalidomide, membranoproliferative glomerulonephritis (MPGN)

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 23 Pages 3461-3468

DOI https://doi.org/10.2169/internalmedicine.2882-19

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Abstract

A 72-year-old man presented with a 6-month history of systemic edema. Hyperpigmentation, hemangioma, pleural effusion, IgG-kappa-type monoclonal protein, high vascular endothelial growth factor values, renal failure, and nerve conduction study abnormalities were also present. Multiparameter flow cytometry (MFC) showed 0.2% neoplastic plasma cells (CD38-, CD56-, and kappa-positive; CD19-, CD27-, and lambda-negative) in the bone marrow leading to POEMS syndrome. Cases involving kappa-type POEMS syndrome are extremely rare. A kidney biopsy revealed membranous proliferative glomerulonephritis-like changes in our case. Lenalidomide-dexamethasone therapy improved the renal function. Detection of neoplastic plasma cells by MFC was useful for the accurate diagnosis and treatment evaluation.

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