POEMS is an acronym for a rare multisystem plasma cell disorder that includes polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin abnormalities. It occurs most commonly in men in their 40's and 50's. The cause is not known. It is considered a malignant disorder.
Common symptoms of POEMS include polyneuropathy, with weakness, pain, numbness, and tingling in the feet and later in the hands. Organomegaly with enlargement of the liver (hepatomegaly), spleen (splenomegaly), and lymph nodes (lymphadenopathy). Endocrinopathy that includes dysfunction of multiple endocrine glands, such as the thyroid, testes and ovaries, pancreas, and adrenal glands. Monoclonal gammopathy, which is a bone marrow disorder, with uncontrolled growth of plasma cells that. produce an abnormal monoclonal immunoglobulin (or M-protein), which almost always is a “lambda light chain” paraprotein. Unrestrained growth of plasma cells may result in painful sclerotic bone lesions throughout the body. Skinabnormalities include abnormal hyperpigmentation, excessive hair growth (hypertrichosis), hardening and thickening of the skin (sclerosis), and excessive sweating (hyperhidrosis).
Still other symptoms include swelling of the optic disk (papilledema), with visual problems, pleural effusions, ascites, fever, kidney disease, and pulmonary hypertension.
Lymphoproliferative disorders, such as Castleman's disease, may further complicate POEMS.
Laboratory testing usually demonstrates the presence of a monoclonal gammopathy, elevations of certain cytokines, such as TNF, interleukin 1 and 6, and elevated platelet counts. Vascular endothelial growth factor (VEGF) is typically elevated, although its significance has not been established. Bone marrow biopsy may show an increased number of plasma cells and is required to differentiate POEMS from multiple myeloma and other lymphoproliferative disorders. Skeletal imaging studies often reveal osteosclerotic bone lesions.
POEMS is considered a malignant (neoplastic) disorder. When the disease is widespread, with multiple tender osteosclerotic lesions and diffuse bone marrow involvement, treatment with prednisone and immunosuppressive drugs, like cyclophosphamide or melphalan, may control symptoms and may stabilize the condition. However, definitive treatment may require high-dose chemotherapy with peripheral blood stem cell transplant.
A useful summary of POEMS may be found in an article by Dr. Andrea Nozzaat in the journal Mediterr J Hematol Infect Dis. 2017; 9(1): e2017051.
Disability Benefits for POEMS
Long term disability (LTD) benefits for POEMS under Social Security (SSDI) is probably best evaluated in the “Listings” (the Blue Book) under 13.28 "cancers treated with bone marrow replacement":
or possibly under “multiple myeloma” at 13.07. POEMS is not the same as multiple myeloma, but they are similar to the extent that they are both neoplastic disorders of plasma cells in the bone marrow.
Because POEMS is a multisystem disorder, it can affect many organs and tissues and cause widespread symptoms, with functional disability based on those symptoms. It is a serious condition that often requires aggressive treatment with radiation, chemotherapy, and stem cell transplant (SCT).
At Law Med, we understand the medical and legal aspects of POEMS and can work with your hematologist/oncologist to help you get the LTD benefits that you are entitled to.