Clinical Impact of Osteolytic Bone Lesions in POEMS Syndrome: A Single-Center Experience of 114 Patients

POEMS syndrome is a multisystemic disease associated with monoclonal plasma cell disorders. Although the presence of bone lesions is included in the diagnostic criteria, their precise manifestations remain unknown. Here, we retrospectively analyzed the bone lesions in patients with POEMS syndrome and evaluated their clinical features. Clinical data and bone lesion information by computed tomography (CT) imaging were obtained from the 114 patients with POEMS syndrome. Regardless of the presence of sclerotic bone lesions, patients were divided into two groups according to the presence (lytic group: n = 17, 14.9%) or absence (non-lytic group: n = 97, 85.1%) of osteolytic lesions. In the lytic group, several patients were histologically diagnosed with plasmacytoma. In the evaluation by CT imaging, osteolytic lesions had a higher response rate than sclerotic lesions (75.0% vs. 42.2%, p = 0.079). Nevertheless, patients in lytic group showed earlier clinical progression than patients in non-lytic group (2-year progression-free survival, 66.7% vs. 90.2%, p = 0.069). The presence of innumerable bone lesions was an independent poor prognostic factor in multivariate analysis, regardless of the presence of osteolytic lesions (hazard ratio, 3.4; 95% confidence interval 1.1–10.9; p = 0.040). Osteolytic and innumerable bone lesions are potential prognostic factors. Further studies involving histopathological evaluations of bone lesions are warranted.