Early weight loss and high serum tumor necrosis factor-α levels in polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes syndrome

We studied tumor necrosis factor‐α (TNF‐α) levels in serial serum samples from 3 consecutive patients who had a complete form of POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes) syndrome and early weight loss. Serum TNF‐α levels were compared with those of 10 patients with multiple my eloma (5) or Waldenström's macroglobulinemia (5). Elevated serum levels of TNF‐α were found in the patients with POEMS syndrome (two‐ to eightfold increase in 10 of 11 samples) and not in those with other malignant plasma cell dyscrasias. These results are in keeping with the hypothesis of a role for nonimmunoglobulinic mediators in the pathogenesis of the POEMS syndrome, and are consistent with previous reports of TNF‐α overproduction in inflammatory demyelinating neuropathies and cachectic states.