ISSN: 2329-8820
Journal of Bone Marrow Research The International Open Access Journal of Bone Marrow Research Executive Editor Dr. Charles E. Egwuagu National Eye Institute National Institute, USA Dr. Robert G. Hawley The George Washington University , USA Chen Wen Yong Beckman Research Institute, USA Dr. Qingdi Quentin Li National Institutes of Health USA Dr. Mortimer Poncz The Children’s Hospital of Philadelphia, USA
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Caldarella et al., J Bone Marrow Res 2013, 1:4 http://dx.doi.org/10.4172/2329-8820.1000e108
Open Access
POEMS Syndrome: The Role of Positron Emission TomographyComputed Tomography using Fluorine-18-Fluorodeoxyglucose (FDG PETCT) Carmelo Caldarella1, Maria Antonietta Isgrò2 and Giorgio Treglia3* Catholic University of the Sacred Heart, Institute of Nuclear Medicine, Rome, Italy Catholic University of the Sacred Heart, Institute of Biochemistry and Clinical Biochemistry, Rome, Italy 3 Oncology Institute of Southern Switzerland, Department of Nuclear Medicine, Bellinzona, Switzerland 1 2
POEMS acronym stands for Polyneuropathy, Organomegaly, Endocrinopathy, M-protein and Skin abnormalities. It describes a rare paraneoplastic syndrome characterized by rapid progression and with a mere 60% survival rate five years after diagnosis, if untreated. Death may be a consequence of infections, renal complications, cardiac or respiratory failure. Positron emission tomography-computed tomography using fluorine-18-fluorodeoxyglucose (FDG PET-CT) has been demonstrated to be helpful in the management of patients affected by multiple myeloma, for staging, re-staging and response to therapy evaluation purposes [1,2]; besides, FDG PET-CT may detect atypical extra-osseous sites of disease in patients with recurrent plasma-cell proliferative disorders, thus allowing an adequate treatment planning [3]. Despite the rarity of the disease, there is recent evidence concerning the role of FDG PET-CT in patients with POEMS syndrome. For staging purposes, in patients with already known or suspected POEMS syndrome, FDG PET-CT may be useful to identify additional bone lesions, otherwise undetected with other imaging techniques (plain X-ray, magnetic resonance imaging, contrast-enhanced CT), and to reveal hypermetabolic changes in bone and lymph nodal lesions, in order to guide diagnostic biopsy of hypermetabolic lesions [4,5]. Also, FDG PET-CT imaging has been demonstrated to have a pivotal role in identifying hypermetabolic bone lesions which may be the target of a focalized radiation therapy in addition to systemic chemotherapy [6]. The entity of FDG uptake in sites of disease, semi-quantitatively measured as Standardized Uptake Value (SUV), may be helpful in the posttreatment evaluation of patients with POEMS syndrome, particularly in those who were given targeted radiation as initial primary therapy, as demonstrated by Humeniuk et al. [7] on 146 patients: a complete disappearance of all baseline pathological spots of FDG activity was defined as a complete response, while a reduction in SUV greater than
50% in comparison with baseline was classified as a partial metabolic response. In conclusion, FDG PET-CT could be considered overall as a valid tool for diagnosis, staging and response to therapy evaluation in patients with POEMS syndrome, even though a combination between FDG PET-CT findings and changes in biochemical markers of disease should be recommended. References 1. Caldarella C, Isgrò MA, Treglia I, Treglia G (2012) Is fluorine-18fluorodeoxyglucose positron emission tomography useful in monitoring the response to treatment in patients with multiple myeloma? Int J Hematol 96: 685-691. 2. Caldarella C, Treglia G (2013) Treatment response monitoring in patients with multiple myeloma: the role of positron emission tomography-computed tomography using fluorine-18-fluorodeoxyglucose. J Bone Marrow Res. 3. Cocciolillo F, Treglia G, Villani MF, Giordano A (2011) Atypical presentation of plasma cell leukemia secondary to multiple myeloma detected by F-18 FDG PET/CT. Clin Nucl Med 36: 220-223. 4. Albertí MA, Martinez-Yélamos S, Fernandez A, Vidaller A, Narváez JA, et al. (2010) 18F-FDG PET/CT in the evaluation of POEMS syndrome. Eur J Radiol 76: 180-182. 5. Tanaka N, Yoshinaga K, Asano C, Kazama H, Okamura T, et al. (2012) Usefulness of (18)F-FDG PET/CT for detecting lesions in patients with POEMS syndrome. Rinsho Ketsueki 53: 2013-2017. 6. Stefanelli A, Treglia G, Leccisotti L, Laurenti L, Luigetti M, et al. (2012) Usefulness of F-18 FDG PET/CT in the follow-up of POEMS syndrome after autologous peripheral blood stem cell transplantation. Clin Nucl Med 37: 181183. 7. Humeniuk MS, Gertz MA, Lacy MQ, Kyle RA, Witzig TE, et al. (2013) Outcomes of patients with POEMS syndrome treated initially with radiation. Blood 122: 68-73.
*Corresponding author: Giorgio Treglia, Oncology Institute of Southern Switzerland, Department of Nuclear Medicine, via Ospedale, 12, 6500, Bellinzona, Switzerland, Tel: +41 918118919; E-mail:
[email protected] Received October 17, 2013; Accepted October 18, 2013; Published October 23, 2013 Citation: Caldarella C, Isgrò MA, Treglia G (2013) POEMS Syndrome: The Role of Positron Emission Tomography- Computed Tomography using Fluorine18-Fluorodeoxyglucose (FDG PET-CT). J Bone Marrow Res 1: e108. doi: 10.4172/2329-8820.1000e108 Copyright: © 2013 Caldarella C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
J Bone Marrow Res ISSN: 2329-8820 BMRJ, an open access journal
Volume 1 • Issue 4 • 1000e108
