A bone marrow biopsy specimen and aspirate were diagnostic of multiple myeloma showing 32 per cent plasma cells in different stages of maturation figure 1. In this type of neoplasm, malignant plasma cells produce either fragments or intact monoclonal immunoglobulins but do not secrete them from the cell. Marrow immunofluorescent studies failed to show production of identifiable immunoglobulins. Nonsecretory multiple myeloma is a rare variant of multiple myeloma characterized by the. Free download myeloma powerpoint presentation slides.
Diagnostic criteria for multiple myeloma major criteria i. Survival of nonsecretory multiple myeloma patients improves. Patients with multiple myeloma mm that present at diagnosis with serum monoclonal protein mig of non secretory are commonly excluded from participation in clinical trials due to undesirable disease. Multiple myeloma with secretory and nonsecretory biclonal. Nonsecretory multiple myeloma nsmm is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma mm patient and immunoglobulin light chain al amyloidosis is a significantly rare complication. Tracking nonsecretory multiple myeloma response to therapy. Nonsecretory multiple myeloma, american journal of. Joining gary on the panel is myeloma advocate, jack aiello. Complications may include amyloidosis the cause of multiple myeloma is unknown.
The treatment of patients with multiple myeloma has dramatically changed over the past 10 years due to an improved understanding of plasma cell biology and the development of new targets. Bone marrow plasmacytosis at greater than 30% was found in all patients and bone x. Diagnostic pitfalls of nonsecretory myeloma manifesting as multiple. Download our cancer publications intl myeloma foundation. Multiple myeloma mm is the second most common hematologic neoplasm in the us, with 30,000 new cases annually. Our results showed that autohct is an effective intervention for nsm patients with comparable outcomes in patients with sm. Jun 14, 2012 i was diagnosed as nonsecretory in 294. Nonsecretory multiple myeloma blood american society of. Pdf nonsecretory multiple myeloma with diagnostic challenges. Mm with biclonal gammopathy are rare and seen in 1 % of all mm cases.
These are cancerous cells that can multiply uncontrollably. Skeletal studies showed mottled lucencies, compression fractures, and diffusely heterogeneous magnetic resonance imaging signal. Plasma cell myeloma and related neoplasms american. Multiple myeloma mm requires detection of monoclonal gammopathy in the serum or urine. It is typically characterized by production of large amounts of. It will help you learn medical terms and concepts you may not have encountered before. All are available free of charge online and in printed copy by mail. Non secretory multiple myeloma with diagnostic challenges. Pdf multiple myeloma mm is the second most common hematologic malignancy in the us. Bone marrow bm examination revealed extensive infiltration by poorly differentiated cells with eccentric nuclei panel a and cytoplasmic luminal inclusions panel b. The data suggest the use of laboratory flc testing for the diagnosis and monitoring of nonsecretory myeloma and al amyloidosis, as a prognostic marker for al amyloidosis, and as a more sensitive marker of lightchain myeloma than urine bence jones protein. We report the case of a 52yearold caucasian man who.
Multiple myeloma is a disorder of the bone marrow which accounts for 1015% of all blood cancers and one to two per cent of all malignancies. Multiple myeloma develops when a normal plasma cell changes into a myeloma cell. The wide application of electrophoretic and immunologic techniques to the study of the paraimmunoglobulins in multiple myeloma has been of great value in the diagnosis and management of this disease. At the time i was told that i should not do any therapy other than stabilizing my spine and local radiation because 3% of nonsecretory patients do not become full blown myeloma patients.
Nonsecretory multiple myeloma and al amyloidosis presenting. Non secretory multiple myeloma mm, charac terized by the absence of detectable. Less common are palpable plasmacytomaswhich grow from areas of. In about 65% of patients, skeletal xray films will show bone lesions that are best seen on lateral skull and anteroposterior pelvic films. Nonsecretory multiple myeloma nsmm accounts for 1 5% of all multiple myeloma mm cases. Current concepts in the evaluation of multiple myeloma. Multiple myeloma mm is the second most common hematologic malignancy in the us. Nonsecretory multiple myeloma in a 26yearold man with. Hofmeister said that having nonsecretory myeloma requires that your disease be followed primarily by bone marrow biopsy, which unfortunately can be painful. Metastatic lobular breast carcinoma mimicking multiple myeloma. Powerpoint is the worlds most popular presentation software which can let you create professional myeloma powerpoint presentation easily and in no time. Serum free lightchain measurements for identifying and. Nonsecretory multiple myeloma nsm represents a variant of multiple myeloma which is characterized by undetectable monoclonal immunoglobulins in serum or urine but with common clinical and laboratory findings.
Monoclonal gammopathy of undetermined significance. Questions to ask your doctor about multiple myeloma. Nonsecretory myeloma nsm is a rare form of my eloma. I had a single plasmacytoma in my fifth cervical vertibra. A single mass of myeloma cells is called a solitary plasmacytoma, which is most often found in the bones but can also be found in soft tissue called an extramedullary plasmacytoma.
Classical techniques of chronic secretions research dont find any immunoglobulin monoclonal peak in the patients blood. Bone marrow examination may be the only method of diagnosis in such cases. Final diagnosis nonsecretory multiple myeloma upmc. Multiple myeloma mm is a plasma cell disorder associated with clonal proliferation of plasma cells. Creating solid records of baseline patient disease characteristics using suggested national comprehensive cancer network diagnostic workup and international myeloma. Nonsecretory multiple myeloma, american journal of hematology. Jul 29, 2004 bone marrow biopsy showed that 80% of the marrow had been replaced by plasma cells. Multiple myeloma early detection, diagnosis, and staging. Nonsecretory multiple myeloma accounts for 1%5% of cases of multiple myeloma.
In 99% of the mm cases, paraproteins are secreted in the serum andor urine, in the remaining 1% the paraproteins are synthesized but not secreted. Are you in need of the most current information about multiple myeloma. Pdf nonsecretory myeloma nsm is a rare form of myeloma. Nonsecretory multiple myeloma nsm is characterized by the absence of detectable monoclonal proteins in serum and urine and accounts for 1% to 5% of all patients with multiple myeloma. The subset of these patients with nonsecretory myeloma a group of patients who do not secrete immunoglobulin or its component parts into either the blood or urinehas been challenging to. Immunohistochemistry revealed amyloid light al amyloidosis of. Lytic bone lesions are rare in this type of myeloma. We report the case of a patient in whom we confirmed multiple myeloma by. Nonsecretory multiple myeloma nsmm is a rare variant of mm and accounts for approximately 1% to 5% of all cases. Multiple myeloma is a cancer that arises from a type of white blood cell called a plasma cell.
Nonsecretory multiple myeloma symptoms, treatments. Quantitation of serum free light chains in combination. The neoplastic cells strongly and uniformly expressed pax5 c, cd20 d. Nonsecretory multiple myeloma with lytic bone lesions. Myeloma is a cancer of plasma cells that begins in the bone marrow. Among 186 patients with multiple myeloma mm, five women were diagnosed as having mm without m. A case of nonsecretory multiple myeloma with careful study of urine and serum immunoglobulins is presented. We report a 26yearold man with aidsassociated multiple myeloma, who had a highly unusual presentation and clinical course. A diagnosis of nonsecretory multiple myeloma was made. Nonsecretory myeloma, which comprises 15% of all myelomas, is a variant of plasma cell myeloma. Characterised by a malignant proliferation ofplasma cells derived from a single clone most common. Nonsecretory multiple myeloma nsmm is a rare variant of multiple myeloma mm that accounts for 1%. Survival of nonsecretory multiple myeloma patients improves over last decade by maike haehle from the myeloma beacon results of a recent retrospective study conducted at the mayo clinic indicate that the survival of patients with nonsecretory multiple myeloma has improved over the last decade. These tumors occur in approximately 1% of all cases of multiple myeloma and are referred to as nonsecretory multiple myeloma.
Although multiple myeloma is one of the most common malignancies in the united states, nsmm accounts only for approximately 1% of these cases. Myeloma is called multiple because it frequently involves multiple areas in the body. However, measurement of serum free light chains has not yet become. We report the case of a 52yearold caucasian man who presented to our hospital because of leukocytosis. As it progresses, bone pain, bleeding, frequent infections, and anemia may occur. Nonsecretory myeloma is a myeloma subtype with evolving diagnostic criteria. The biopsy showed a diffuse infiltrate of similarappearing lymphoid cells b. In about one to five per cent of cases these may not be demonstrated and these cases are termed as nonsecretory multiple myeloma. Survival of nonsecretory multiple myeloma patients improves over last decade. Plasma cells originate in the bone marrow and play an important role in the immune system. It is defined as monoclonal plasmocytic prolif eration of the bone marrow with the same clinical and. Mieloma multipel nonsecretory nonsecretory multiple myeloma. Supplementary appendix this appendix has been provided by the authors to give readers additional information about their work. Here, we report two cases of nonsecretory plasma cell myeloma that manifested as multifoci.
Nonsecretory multiple myeloma nonsecretory multiple myeloma bourantas, k. A, the bone marrow aspirate contained numerous lymphoplasmacytic forms. Information about serum flc measurement in nonsecretory myeloma, monoclonal light chain diseases, and reference populations is reported in the literature 15,7, but there is limited data about flcs in renal disease, monoclonal gammopathy of undetermined significance mgus, and myeloma patients after autologous stem cell transplants. Jun 21, 2010 if not, your myeloma would need to be followed by periodic bone marrow biopsies and xrays, but he cautions that these are not very accurate methods. Sharing clinical, therapeutic, and prognostic characteristics with mm, real challenge. Microabstractin this analysis, we focused on the importance of establishing baseline characteristics in multiple myeloma patients in the connect mm registry. Double autologous stem cell transplantation in a case of. Multiple myeloma mm accounts for 10 % of hematological malignancies. In the developed countries like in europe, cases of mm ranged from 4.
Multiple myeloma memorial sloan kettering cancer center. Monitoring nonsecretory multiple myeloma the assessment of disease burden using routine marrow histology and flow cytometry is notoriously inaccurate, due in large part to the patchy nature of marrow involvement and issues with sampling 337. Sep 11, 20 the emergence of multiple myeloma as a second malignancy in patients with essential thrombocythemia is extremely rare. Pdf nonsecretory myeloma is a myeloma subtype whose. Nonsecretory myeloma, which comprises 15 % of all myelomas, is a variant of plasma cell myeloma. Malignant transformation of more differentiated lymphoid cells has not been well described in these patients. Nonsecretory multiple myeloma mm, charac terized by the absence of detectable.
Some early cancers may have signs and symptoms that can be noticed, but that is not always the case. The relationship between nonsecretory multiple myeloma and amyloidosis is discussed. Jan 11, 2016 myeloma classification monoclonal gammopathy of undetermined significance serum mprotein 3 gdl andor bone marrow plasma cells. Lytic bone lesions are commonly associated with multiple myeloma. Nonsecretory mm may mean the body does not secrete mprotein or there is no detectable mprotein even within the malignant plasma cells present. The emergence of nonsecretory multiple myeloma during the. The emergence of multiple myeloma as a second malignancy in patients with essential thrombocythemia is extremely rare. Nonsecretory myeloma article about nonsecretory myeloma by. Monoclonal gammopathy of undetermined significance mgus is defined by the presence of a serum monoclonal protein mprotein at. Normal pcs are uniquely programmed to generate significant. The patient may present with a range of severity of symptoms including fatigue.
Nonsecretory multiple myeloma blood american society. Patients with multiple myeloma mm that present at diagnosis with serum monoclonal protein mig of pdf nonsecretory multiple myeloma nsmm is a rare variant of the classic form of multiple myeloma mm. This is why autologous stem cell transplantation is included in the standard treatment of myeloma patients. Multiple myeloma represents a challenge for hematologists because it has become more frequent at a young age in recent years. Nonsecretory multiple myeloma was thus diagnosed, and the patient was started on chemotherapy.
Some people with multiple myeloma dont make enough m proteins or light chains for tests to show they have it. This variant of multiple myeloma mm usually poses a diagnostic challenge to the biologist and clinician. Nonsecretory multiple myeloma is a rare variant of multiple myeloma. Jun 15, 2010 accepting the fact that nonsecretory multiple myeloma does not leave much of a trail, how does a physician treating patients with nonsecretory multiple decide what scans, blood test, etc are the most useful in identifying how the patient is responding to therapy and, if any are useful, what exacting do they show that makes them so. Mieloma multipel nonsecretory nonsecretory multiple myeloma the incidence of nonsecretory multiple myeloma ranged between 1. Jan 02, 2009 grannai too am a nonsecretory mm survivor. Learn about imfs library of cancer articles, journals, and other publications for patients, caregivers, and healthcare professionals. Pdf non secretory multiple myeloma nsmm is a rare variant of the classic form of multiple myeloma mm. Hallmark of most multiple myeloma cases is the persistent production of some form of immunoglobulins, a phenomenon that brings the disease to attention. Outcome of patients with nonsecretory multiple myeloma. The patient handbook focuses on the questions and decisions that a newly diagnosed patient faces. If not, your myeloma would need to be followed by periodic bone marrow biopsies and xrays, but he cautions that these are not very accurate methods. Pseudofontanelle in multiple myeloma jama jama network. After thorough study, however, in a few patients, clearly documented multiple myeloma is found in.
Nonsecretory multiple myeloma nsmm is a rare clinical and biological variant of the classic form of mm characterized by the absence of monoclonal. Nonsecretory multiple myelomas were first described in 1958 by serre. The subset of these patients with nonsecretory myeloma a group of patients who do not secrete immunoglobulin or its component parts into either the blood. Nonsecretory myeloma definition of nonsecretory myeloma by. Nonsecretory multiple myeloma with diagnostic challenges. Several cases have been published so far, pointing out the impact of a cytotoxic effect during treatment of essential thrombocythemia on the development of multiple myeloma. Microabstractwe report the outcomes of patients with nonsecretory multiple myeloma nsm who were treated with autologous hematopoietic stem cell transplantation autohct compared with a matched cohort with secretory myeloma sm. The good news is that statistically non secretors live longer, the bad news is that it is more difficult to track our levels.
Nonsecretory multiple myeloma is a bone marrowbased cancer that arises in plasma cells. Nonsecretory multiple myeloma american journal of medicine. Nonsecretory multiple myeloma nonsecretory multiple myeloma dreicer, robert. This helps you give your presentation on myeloma in a conference, a school lecture, a business proposal, in a webinar and business and professional representations. Many core booklets and key medical articles are translated as well. Nonsecretory multiple myeloma presenting as primary plasma cell. Monoclonal gammopathy of undetermined significance an. Double autologous stem cell transplantation in a case of non. My cohost for the talk is myeloma advocate and editor of, gary petersen. The disease is characterised by the absence of detectable monoclonal proteins in serum and urine using immunofixation electrophoresis ife, although the degree of bone marrow plasma cell infiltration is similar to that found in secretory patients. However, a small subset of mm called nonsecretory multiple myeloma nsmm produces no detectable ig. Only 2 % of patients are younger than 40 years of age. Pdf nonsecretory multiple myeloma nsmm is a rare variant of the classic form of multiple myeloma mm. Multiple myeloma mm, also known as plasma cell myeloma and simple myeloma, is a cancer of plasma cells, a type of white blood cell that normally produces antibodies.
Plasma cell myeloma with small lymphocytelike morphologic features, t11. Current concepts in the evaluation of multiple myeloma with. Variations were observed in the percentage of reported baseline data. Nonsecretory myeloma is a rare variety of multiple myeloma. A rare case of nonsecretory multiple myeloma in lagos, nigeria. A case of nsmm with al amyloidosis and nephrotic range proteinuria is presented. Multiple myeloma early detection, diagnosis, and staging 1. Based on studies of welldefined patient groups, serum free light chain sflc measurement has become an important tool in the diagnosis and monitoring of the monoclonal gammopathies, light chain multiple myeloma lcmm, nonsecretory myeloma, and primary amyloidosis al. Ige i igd % light chain 20% 1% of cases are nonsecretory. Nonsecretory multiple myeloma relapsing as extramedullary liver. Nonsecretory multiple myeloma, european journal of. Survival of nonsecretory multiple myeloma patients. This is priya menon joining you from india on curetalks 121st episode. A rare case of nonsecretory multiple myeloma in lagos.
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