Low-secretory multiple myeloma

Loading...
Thumbnail Image

Date

Authors

Visser, Hilgaard Frans
Visser, Adele
Nel, J.M.
Moodley, Vanessa
Swart, Andre
Pool, Roger

Journal Title

Journal ISSN

Volume Title

Publisher

South African Orthopaedic Association / Char Publications

Abstract

Multiple myeloma (MM) is an incurable malignancy arising from postgerminal B lymphocytes. It is estimated to account for 10-15% of haematological malignancies and 1% of all malignancies. Non-secretory multiple myeloma (NSMM) is a rare variant of MM, where no monoclonal immunoglobulin (M-protein) can be demonstrated in either the urine or serum. NSMM is estimated to occur in 1-5% of all myeloma cases. So-called 'low-secretory' forms also exist, where the degree of immunoglobulin production does not fulfil the diagnostic criteria, but monoclonal production does occur. The lack of M-protein in NSMM may be due to the inability of the plasma cell to excrete the immunoglobulin, an inherent low synthetic capacity, or intra- or extra-cellular degradation of the M-protein upon production. Patients typically present with fatigue, bone pain and recurrent infections. Bone involvement is common in this disorder with an estimated 80% of patients having radiographic abnormalities upon diagnosis. The majority present with focal lytic lesions (~60%), with osteoporosis (~20%), pathological fractures (~20%) and spinal compression fractures (~20%) seen in the remainder. Metastatic disease is a significant contributor to patient morbidity, since it significantly affects the patient's ability to perform activities of daily living. The humerus is the second-most common site affected after the femur. Surgical intervention is aimed at providing pain relief and restoration of limb function, and is usually not indicated in patients with a very short life expectancy, but this practice remains controversial. In this report we describe a patient with a low-secreting myeloma, presenting with a pathological fracture, in which establishment of the diagnosis according to the World Health Organization (WHO) criteria required crative sampling.

Description

Keywords

Multiple myeloma, Low-secretory, Non-secretory multiple myeloma, NSMM

Sustainable Development Goals

Citation

Visser, HF, Visser, A, Nel, JM, Moodley, V, Swart, A & Pool, R (2009), 'Low-secretory multiple myeloma', SA Orthopaedic Journal, vol. 8, no. 4, pp. 76-80. [http://www.charpublications.co.za/C_JournalsORTH.asp]