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Secretory vs. Non-Secretory Myeloma

Multiple Myeloma Stages
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What is non-secretory myeloma? We’ve all heard and read these labels but you may not know what they mean. So what is the difference?

Secretory  myeloma is the regular, old, multiple myeloma. Plasma cells multiply and secrete chemicals. It is a bunch of these chemicals that are tested for to try to determine how advanced the patient actually is. So it is non-secretory myeloma that we must focus on.

Full disclosure- I was diagnosed as non-secretory in January of 1994. A single plasmacytoma in my fifth cervical vertebra had caused the bone to break. I underwent surgery and local radiation to the site. The hope was that my MM had not spread beyond the single site. I developed extensive bone lesions in less than a year so I’m guessing that my MM had spread beyond the original single plasmycytoma site.

According to research, approximately 3 percentTrusted Source of myeloma cases are non-secretory myeloma. While this number was once thought to be higher, better testing has shown that in many people with myeloma, the cancer cells actually do make some component of antibodies.

What is non-secretory multiple myeloma?

  • Absence of M-protein: In most cases of multiple myeloma, patients produce large quantities of abnormal antibodies that can be detected in the blood or urine. However, in NSMM, these M-proteins are either not produced or are produced at levels too low to be detected by standard tests.
  • Diagnosis: The diagnosis of NSMM is more challenging due to the absence of detectable M-protein. It typically involves a combination of bone marrow biopsy, imaging studies, and other laboratory tests. The bone marrow biopsy often reveals the presence of malignant plasma cells.
  • Clinical Features: Patients with NSMM present with symptoms similar to those of secretory multiple myeloma, such as bone pain, anemia, kidney dysfunction, and increased risk of infections. The lack of M-protein may delay diagnosis.
  • Imaging Studies: Advanced imaging techniques like MRI or PET-CT scans are crucial in diagnosing NSMM as they can reveal bone lesions and other complications associated with the disease.
  • Treatment: The treatment for NSMM is generally similar to that for secretory multiple myeloma and may include chemotherapy, immunotherapy, targeted therapy, and stem cell transplantation. However, the monitoring of treatment response relies more on imaging studies and bone marrow biopsies rather than blood or urine tests for M-proteins.
  • Prognosis: The prognosis for NSMM can vary widely depending on various factors, including the extent of the disease at diagnosis and the patient’s overall health. As with other forms of multiple myeloma, early detection and appropriate treatment are critical for improving outcomes.

Much of being a non-secretory MM patient is the same as being a secretory MM patient. The main challenge faced by the non-secretory patient is the lack of diagnostic info to base your decisions on. And you may need to undergo more bone marrow biopsies. After all, sampling your bone marrow is the only real way to determine the amount of plasma cells in your bone marrow.

Have you been diagnosed as a non-sectretory MM patient? What are your symptoms? What are you thinking about as your treatment plan? If you have any questions about being non-secretory email me at David.PeopleBeatingCancer@gmail.com

Hang in there,

David Emerson

  • MM Survivor
  • MM Cancer Coach
  • Director PeopleBeatingCancer

Non-Secretory Myeloma: Ready for a new Definition?

Non-secretory myeloma is a rare myeloma subtype whose diagnosis, until a few years ago, was established by demonstration of monoclonal plasma cells ≥10% in the bone marrow and by negative results on serum and urine electrophoresis and immunofixation studies.

However, this type of myeloma could be misdiagnosed if the workup does not include an accurate study of serum free light chain test since some of the patients diagnosed as non-secretory could be light chain only with small amounts monoclonal proteinuria.

Due to this limit in classification, all the information available today, generally coming from retrospective studies including patients studied completely and incompletely, could be misleading. A new definition is, thus, needed to distinguish between the true non-secretory, with a possible better prognosis, and the other forms of oligo-secretory myeloma with a prognosis more similar to the secretory form of myeloma.

With all the data of the literature, the availability of laboratory and radiological tools, times are mature to depict a new definition of nonsecretory myeloma that deserves a peculiar work up and different response evaluation and, may be, a different therapeutic approach.

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