Comparable Outcomes in Nonsecretory and Secretory Multiple Myeloma after Autologous Stem Cell Transplantation

Kumar, Shaji; Pérez, Waleska S.; Zhang, Mei Jie; Ballen, Karen K.; Bashey, Asad; To, Luen Bik; Bredeson, Christopher; Cairo, Mitchell S.; Elfenbein, Gerald J.; Freytes, César O.; Gale, Robert Peter; Gibson, John; Kyle, Robert A.; Lacy, Martha Q.; Lazarus, Hillard M.; McCarthy, Philip L.; Milone, Gustavo; Moreb, Jan S.; Pavlovsky, Santiago; Reece, Donna; Wiernik, Peter H.; Hari, Parameswaran

doi:10.1016/j.bbmt.2008.07.011

Cited by 29 publications

(27 citation statements)

References 25 publications

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“…The survival of patients with non-secretory myeloma treated conventionally has been reported to be similar to that of patients with common myeloma. 1,24 In a single-institution study of transplanted patients, those with non-secretory myeloma had a significantly better outcome than patients with all other myeloma types although there were only six cases of non-secretory myeloma in the series. 25 The current much larger study suggests that non-secretory myeloma behaves similarly to common myelomas and should be treated similarly.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and outcome of autologous transplantation in rare myelomas

Morris¹,

Drake²,

Apperley³

et al. 2010

Haematologica

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BackgroundAs rare myelomas, i.e. the IgD, IgE, IgM and non-secretory forms, constitute only a small proportion of any study, relatively little is known about their prognosis in the era of peripheral stem cell transplantation. Design and MethodsWe used the European Group for Blood and Marrow Transplantation Myeloma Database to compare the outcome following autologous transplantation of over 20,000 patients with common myelomas (IgG, IgA and light chain myeloma) with the outcome of patients with rare myelomas: 379 IgD, 13 IgE, 72 IgM and 976 non-secretory cases. ResultsThe study confirms the multiple adverse prognostic factors seen in IgD myeloma. Somewhat surprisingly, patients with IgD and non-secretory myeloma both had higher complete remission rates before and after transplantation than patients with common myelomas. However, while the overall survival of patients with non-secretory myeloma was similar to that of the patients with common myelomas, the survival of patients with IgD myeloma was significantly worse (although better than survival rates reported for non-transplanted patients); this was due to higher transplant-related mortality and relapse/progression rates. The post-transplantation survival of patients with IgE or IgM myeloma appears to be very poor. ConclusionsThis study provides data on the biological features of rare myelomas. The overall survival of patients with IgD, IgE or IgM myeloma is poor following autologous transplantation but substantially better than that reported for patients who were not transplanted. Key words: rare myelomas, autologous transplantation, outcome, efficacy. . Haematologica 2010;95(12):2126-2133. doi:10.3324/haematol.2010 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Citation: Morris C, Drake M, Apperley J, Iacobelli S, van Biezen A, Bjorkstrand B, Goldschmidt H, Harousseau J-L, Morgan G, de Witte T, Niederwieser D, and Gahrton G for the Myeloma Subcommittee of the Chronic Leukaemia Working Party of the EBMT. Efficacy and outcome of autologous transplantation in rare myelomas Efficacy and outcome of autologous transplantation in rare myelomas

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Section: Discussionmentioning

confidence: 99%

Efficacy and outcome of autologous transplantation in rare myelomas

Morris¹,

Drake²,

Apperley³

et al. 2010

Haematologica

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“…Kumar et al describe atypical presentations of non-secretory MM and their frequent association with multiple bone lesions and plasmacytomas. Th ey proved similar outcome and prognosis in these patients after autologous stem cell transplantation compared to the classic MM form 11 . Our patients shared the presenting features reported by most of the authors with identical MS in the two groups after therapy with bortezomibbased regimens and radiotherapy.…”

Section: Discussionmentioning

confidence: 59%

“…Minimal suppression of hematopoiesis and low M-grade with rare immune paresis is refl ected by the unusual normal levels of hemoglobin 10 , platelets and β2M, and preserved renal function. Th e most prominent feature of MF-MM is massive involvement of skeleton and frequent associations with soft tissue plasmacytomas 11 . Th ere are contradictory data concerning the outcome of these patients.…”

Section: Discussionmentioning

confidence: 99%

Multiple Myeloma with Advanced Bone Disease and Low Tumor Burden – Different Clinical Presentation but Similar Outcome after Bortezomib-Based Therapy and Radiotherapy

Goranova-Marinova

Deneva

et al. 2017

acc

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SUMMARY -Th ere is a small but well recognized group of patients with multiple myeloma (MM), characterized by multiple bone lesions and low tumor burden, the so-called macrofocal form of MM (MF-MM). Th e aim of the study was to analyze the incidence, clinical manifestation, therapeutic outcome and prognosis of patients with MF-MM treated with bortezomib-based therapy and radiotherapy, in comparison to classic MM. Th ere were 148 MM patients treated with bortezomibbased regimens, with 15 (10.1%) of them meeting the criteria for MF-MM. Comparative analysis involved disease-and therapy-related variables and markers of bone metabolism in MF-MM and classic MM groups. Event-free survival (EFS) and median survival (MS) were analyzed. Patients in MF-MM and classic MM groups had similar mean age and sex distribution. Patients with MF-MM had advanced myeloma bone disease (MBD), signifi cantly lower clonal plasma cell infi ltration in bone marrow, and lower paraprotein level. Th ese patients were predominantly in an early International Staging System stage, showed non-secretory and light-chain variants, and signifi cant association with extramedullary plasmacytomas. EFS was 20 months in MF-MM group versus 13 months in classic MM group (nonsignifi cant diff erence). MS was 42 months in both MF-MM and classic MM groups. MF-MM presents with imbalance of the minimal tumor burden and massive bone involvement. Along with advanced skeletal manifestations, these patients showed features of preserved bone marrow and no end-organ damages. Following bortezomib-based therapy and radiotherapy, the EFS and MS did not diff er between MF-MM and classic MM groups.

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“…[10,11] The presenting features of non-secretory myeloma, response to therapy and survival are similar to those of patients with measurable M-proteins. [4] However, there is bound to be some delay in diagnosis as they do not demonstrate the paraprotein in blood or urine which may shorten their survival This patient was symptomatic and was diagnosed with help of serum free light chain assay and hence was a producer but non-secretor. She responded very well to thalidomide and dexamethasone along with bisphosphonate with subjective improvement of her symptoms and lowering of serum levels of beta 2 microglobulin.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4] A search for "non-secretory multiple myeloma" in the PubMed, yielded less than 80 case reports since 1972. These patients are often a diagnostic dilemma and a high index of suspicion should be borne in mind, especially in a patient with osteolytic lesions.…”

Section: Introductionmentioning

confidence: 99%

Non-Secretory Multiple Myeloma- A Diagnostic Dilemma: A Case Report

Kumar¹,

Bhatia²,

Khurana³

et al. 2017

AIMDR

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Nonsecretory myeloma, which comprises 1-5% of all myelomas, is a variant of plasma cell myeloma. It is defined as symptomatic myeloma without detectable monoclonal immunoglobulin levels on serum or urine immunofixation electrophoresis. It often poses diagnostic dilemma with no clear features of the disease. Our case report examplifies such a diagnostic dilemma. We report a case of nonsecretory plasma cell myeloma that manifested as nonspecific backpain and lytic skull lesions. Due to the inability to detect monoclonal immunoglobulin on serum or urine immunofixation electrophoresis it was difficult to establish an early, accurate diagnosis. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or osteolytic lesion. Misdiagnosing or mislabeling symptomatic myeloma patients results in the delay of their systemic treatment. Therefore, comprehensive imaging studies, the detection of free light chains, and histopathological confirmation from different sites and time points are necessary.

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Comparable Outcomes in Nonsecretory and Secretory Multiple Myeloma after Autologous Stem Cell Transplantation

Cited by 29 publications

References 25 publications

Efficacy and outcome of autologous transplantation in rare myelomas

Efficacy and outcome of autologous transplantation in rare myelomas

Multiple Myeloma with Advanced Bone Disease and Low Tumor Burden – Different Clinical Presentation but Similar Outcome after Bortezomib-Based Therapy and Radiotherapy

Non-Secretory Multiple Myeloma- A Diagnostic Dilemma: A Case Report

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