Clinical course and prognosis of non‐secretory multiple myeloma

Abstract

Non-secretory myeloma is an uncommon subtype of multiple myeloma. In the last decade, there has been an improvement in the survival of non-secretory myeloma and appears superior to secretory myeloma.

Nonsecretory Multiple Myeloma Presenting as Recurrent Vertebral Compression Fractures in an Older Male Patient

“…2,5) The clinical course and prognosis of NSMM have not been well studied, since assessment of response and identification of relapse are more difficult given the absence of the monoclonal protein typically used for this purpose in the clinical settings. 8) However, based on current studies, NSMM appears to be less aggressive than secretory MM. 4) Chawla et al 8) examined the survival and prognosis of 124 NSMM patients in a retrospective study, and the study included SFLC testing where available.…”

“…4) In addition, the overall survival was superior in patients with a normal baseline FLC ratio compared to that in patients with an abnormal ratio. 8) Vertebral collapse with back pain is a common symptom of MM. However, a delayed diagnosis of MM is not uncommon because vertebral compression fractures are relatively prevalent, especially in elderly with osteoporosis; 10% to 25% of patients with MM present with diffuse osteopenia instead of osteolytic lesions, with or without fractures.…”

Non-secretory multiple myeloma: from biology to clinical management

“…At that time, ELISA-based SFLC testing was not commercially available and therefore it is unclear how many of the NSMM patients actually had light-chain MMs. In a retrospective study by Chawla et al13 in 2015, the survival and prognosis of 124 NSMM patients were examined, and the study included SFLC testing where available. They demonstrated that time to progression, progression-free survival (PFS), and overall survival (OS) prior to 2001 were similar between NSMM patients and secretory MM patients.…”

“…However, it appeared that the improvement in OS was greater in the NSMM group. Interestingly, the survival gain was not seen in patients treated with high-dose chemotherapy and autologous stem cell transplantion 13,31…”

“…In fact, retrospective studies examining standard approaches13 and autologous stem cell transplantation (ASCT)13,33 are underpowered for specifically examining NSMM, but as mentioned already, it appears that NSMM may do equally well if not better than secretory MM. Consequently, until data emerge to suggest other pathways, treatment of NSMM should follow the same guidelines as those provided for secretory MM.…”