Effective front-line treatment of osteosclerotic myeloma with POEMS syndrome with daratumumab, lenalidomide and dexamethasone: a case report and literature review

POEMS syndrome is a rare paraneoplastic disorder caused by an underlying plasma cell dyscrasia, characterized by a constellation of clinical features including polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and sclerotic bone lesions. Due to its rarity and variable presentation, diagnosis is often delayed. We present a case of POEMS syndrome in which the patient was initially ineligible for autologous stem cell transplantation (ASCT) due to poor performance status. Front-line treatment with daratumumab, lenalidomide, and dexamethasone (DRd) resulted in a rapid and durable clinical and biochemical response, including normalization of vascular endothelial growth factor levels. This improvement ultimately enabled the patient to successfully undergo ASCT.This case highlights the potential role of DRd as an effective induction strategy in functionally impaired patients with POEMS syndrome.