Núñez-Cortés, Ana Karen; Olivares-Gazca, JuCantero-Fortiz Y, Vallejo- Villalobos MF, Ruiz-Delgado GJ, Sánchez-Sosa S, Ruiz-ArgüellesGJ

Language: English
References: 14
Page: 54-58
PDF size: 278.91 Kb.

ABSTRACT

Multiple myeloma is a neoplastic monoclonal gammopathy. It is characterized by malignant clonal proliferation of plasma cells in the bone marrow microenvironment and monoclonal protein in urine or blood. Non-secretory myeloma (NSMM) is a rare presentation of multiple myeloma, which occurs in 1% of patients. There is limited data on the clinical course, therapeutic response and outcome of these patients. This paper reports the case of a 64-year-old Hispanic female who had a rapid progression of the disease as well as massive osteolytic activity. The physical examination was unremarkable, and all vital signs were within normal limits. Histopathologic findings at the time of diagnosis showed hypercellular bone marrow and neoplastic plasmatic cells suggestive of multiple myeloma. The flow-cytometric analysis of the bone marrow cells disclosed an abnormal monoclonal population of plasma cells representing 25% of the nucleated cells in the bone marrow. A bone marrow aspirate revealed hipercellularity plasmocytic infiltration (45.6%). Bone marrow trephine biopsy showed interstitial pattern in immunohistochemistry test was positive for CD38 in 25% plasmatic cells. Polyclonal light chains were positive in less than 5% plasma cells and myeloperoxidase was positive in myeloid series. Non-secretory multiple myeloma is considered to be treated as secretory multiple myeloma. There are unspecific protocol treatments for this disease due to the lack of evidence and guidelines.

REFERENCES

1. Cantero-Fortiz Y, León-Peña AA, León-González M, Ruiz- Delgado GJ. Central Nervous System Involvement in multiple myeloma. Rev Hematol Mex 2016;17(1):63-6.

2. Palumbo A, Anderson K. Multiple myeloma. N Engl J Med 2011;364(11):1046-60.

3. Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med 2004;351:1860-74.

4. Coriu D, Weaver K, Schell M, Eulitz M, Murphy CL, Weiss DT, Solomon A. A molecular basis for nonsecretory myeloma. Blood 2004;104(3):829-31.

5. Avet-loiseau H, Garand R, Lodé L, Harousseau J, Bataille R, Dc W, Garand R, Lode L. nonsecretory multiple myeloma variants brief report translocation t (11;14)(q13;q32) is the hallmark of IgM, IgE, and nonsecretory multiple myeloma variants. Blood 2013;101(4):1570-1.

6. Durie BGM, Salmon SE. A clinical staging system for multiple myeloma. Cancer 1975;36:842-54.

7. Drayson M, Tang LX, Drew R, Mead GP, Carr-smith H, Bradwell AR. Serum free light-chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Brief report serum free lightchain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2011;97(9):2900-2.

8. Taroeno-Hariadi KW, Purwanto I, Kurnianda J, Mangunsudirjo S, Harijadi A. Non secretory multiple myeloma – a case report. Med J Indones 2007;16(4):257-61.

9. Euch ME, Ismail FBF, Rezgui A, Karmani M, Derbali F, Amri R. Non-secretory multiple myeloma with lytic bone lesions about a new observation. Open J Intern Med 2012;2012:179-82.

10. Birgegård G. Managing anemia in lymphoma and multiple myeloma. Ther Clin Risk Manag 2008;4(2):527-39.

11. Birgegård G, Gascón P, Ludwig H. Evaluation of anaemia in patients with multiple myeloma and lymphoma: Findings of the European Cancer Anaemia Survey. Eur J Haematol 2006;77(5):378-86.

12. Lonial S, Kaufman JL. Non-secretory myeloma: a clinician’s guide. Oncology 2013;27:924-8930.

13. International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders. Br J Haematol 2003;121:749-57.

14. Anderson KC, Alsina M, Bensinger W, Biermann JS, et al. Multiple myeloma, Version 1. 2013 Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw 2013;11:11-7.