Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?

While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...

If you have identified somebody with neuropathy and a monoclonal IgM protein, there are a few things you can/should do to get to the underlying diagnosis. The question is whether these are true, true, and unrelated or in fact, part of the same disease process.

1) EMG/NCS - presumably this has been ...

POEMS workup mimics a routine myeloma workup plus VEGF.

Amyloid-paraprotein levels per myeloma (SPEP, sIFE, free light chains, QIgs, chemprofile), bone marrow aspirate/biopsy with flow, cytogenetics, FISH, NGS; 24-hour urine for TUP, UPEP, uIFE radiographs usually not necessary if truly just amyloid...

The key aspect of a paraprotein to decide whether to investigate for POEMS and/or amyloid is the light chain. POEMS is almost always a lambda light chain, as is AL amyloid (I say almost because nothing is absolute and there must be a case reported of kappa?). Most POEMS is IgG or IgA- so an IgM kapp...