EARLY WEIGHT-LOSS AND HIGH SERUM TUMOR NECROSIS FACTOR-A LEVELS IN POLYNEUROPATHY, ORGANOMEGALY, ENDOCRINOPATHY, M-PROTEIN, SKIN CHANGES SYNDROME

We studied tumor necrosis factor-alpha (TNF-alpha) levels in serial se rum samples from 3 consecutive patients who had a complete form of POE MS (polyneuropathy, organomegaly, endocrinopathy, M protein, skin chan ges) syndrome and early weight loss. Serum TNF-alpha levels were compa red with those of 10 patients with multiple myeloma (5) or Waldenstrom 's macroglobulinemia (5). Elevated serum levels of TNF-alpha were foun d in the patients with POEMS syndrome (two- to eightfold increase in 1 0 of 11 samples) and not in those with other malignant plasma cell dys crasias. These results are in keeping with the hypothesis of a role fo r nonimmunoglobulinic mediators in the pathogenesis of the POEMS syndr ome, and are consistent with previous reports of TNF-alpha overproduct ion in inflammatory demyelinating neuropathies and cachectic states.