Clinical Features

The main presenting features in four series of nonsecre-tory myeloma with at least seven patients are shown in Table 84.4. In the largest series, consisting of 29 patients, the median age was a decade younger than that of a usual patient with myeloma. In that series, almost 70% of patients had low tumor mass. No patient had a hemoglobin level less than 11 g/dL or renal failure, and only two patients had hypercalcemia. In the other series, the presenting features of nonsecre-tory myeloma were similar to those in patients with M

Table 84.4

Nonsecretory myeloma: presenting features in four series including at least seven patients

Azar et al.71 Alexanian73 Cavo et al.72 Bourantas82

No. of patients 7

Median age (years) 62

Hemoglobin <11 g/dL, no. of patients 6

Calcium >11.5 mg/dL, no. of patients NR

Creatinine >2 mg/dL, no. of patients NR

High tumor mass (stage III disease), NR no. of patients

Lytic bone lesions, no. of patients 6

No. of patients 7

Median age (years) 62

Hemoglobin <11 g/dL, no. of patients 6

Calcium >11.5 mg/dL, no. of patients NR

Creatinine >2 mg/dL, no. of patients NR

High tumor mass (stage III disease), NR no. of patients

Lytic bone lesions, no. of patients 6

NR, not reported.

aStage not including skeletal involvement. From Ref. 41, with permission from Elsevier.

protein, except for the absence of renal insufficiency. Most patients had stage III disease, and the majority had a marked reduction of normal polyclonal immunoglobulins. Almost all patients had lytic lesions.

In the series of 29 patients, the condition remained nonsecretory throughout in 22 patients (76%). During follow-up, M protein developed in the serum in five patients (two with monoclonal heavy chain and three with monoclonal light chain). In two others, a monoclonal light chain developed in the urine. The unin-volved immunoglobulins were reduced in 92%. None of the patients with nonsecretory myeloma had a serum creatinine value more than 2 mg/dL. In contrast, the serum creatinine value was increased in 35% of the patients with light-chain myeloma. Median duration of survival was 38 months for patients with nonsecretory myeloma, 34 months for those with light-chain myeloma, and 33 months for the entire cohort of 1027 patients.42

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