Treatment of polyneuropathy, organomegaly, endocrinopathy, monoclonal 
gammopathy, and skin changes (POEMS) syndrome should be directed at the 
underlying plasma cell clone with risk-adapted therapy based on the extent of 
the plasma cell disorder. Radiation therapy is effective for patients with a 
localized presentation, without bone marrow involvement, and 1 to 3 bone 
lesions. Patients with disseminated disease should receive, preferably, 
high-dose chemotherapy with peripheral blood transplantation. Low-dose melphalan 
and dexamethasone or new agents used in myeloma are also effective. The most 
promising agent is lenalidomide, which could be given before high-dose therapy 
or radiation to get rapid neurologic responses.