POEMS SYNDROME: AN UPDATE

Abstract

POEMS syndrome is a rare, chronic and disabling condition. The causes of this condition remain unknown; however, chronic overproduction of pro-inflammatory cytokines appears to be a major contributor. Early diagnosis is essential to start treatment before the clinical condition of the patient becomes compromised.

A complete evaluation of the disease at its onset is essential for treatment decision. In localized disease, curative doses of radiation (50 Gy) is the recommended therapy. On the other hand, patients with disseminated disease should be given systemic therapy. Treatment-related morbidity can be minimized by an effective induction therapy that modifies the cytokine status, improving clinical condition and control disease severity before mobilization and transplantation. Patients not suitable for hematopoietic stem cell transplantation (HSCT) are usually treated with alkylator-based therapy. Novel agents may also offer benefits to patients with a poor performance status or renal dysfunction, and induce transplantation eligibility. Given the biological characteristics of POEMS, immunomodulatory effects and the absence of neurotoxicity, lenalidomide appears to be an effective therapy for the treatment of POEMS, both as short induction therapy before PBSCT and in non-transplant eligible patients, as it showed high response rate and long lasting responses.

At present, however, guidelines for the diagnosis and treatment of POEMS are not available and appear advocated.

 Keywords: POEMS, plasma cell dyscrasia; Osteosclerosis; neuropathy