Response To Therapy And Survival

Therapy is similar to that for multiple myeloma. The lack of a measurable M protein makes evaluation of response to therapy difficult. Evaluation of response is based on improvement in the symptoms of bone pain, correction of anemia and hypercalcemia if initially present, reduction of extramedullary plasmacytomas, no increase in lytic bone lesions, and decrease in the proportion of bone marrow plasma cells. The advent of free light-chain assays is useful for monitoring the progress of patients with nonsecretory myeloma. Drayson et al.94 reported abnormal free light chains in 68% of patients with nonsecretory myeloma. Dreicer and Alexanian73 reported that 80% of patients responded to initial chemotherapy.

In several series, survival of patients with nonsecre-tory myeloma was similar to that of patients with a measurable M protein.71'72 79 80 Dreicer and Alexanian73 reported a median duration of survival of 39 months, whereas Bourantas82 noted 45 months. The median of 38 months in our study was not statistically different from that in patients with a measurable M protein.42

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