A case report: Nonsecretory multiple myeloma presenting with bone pain
Qianshuang Geng1, Jie Li2, Xi Li3
1Department of Hematology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China.
Medicine
|February 2, 2024
Summary
Nonsecretory multiple myeloma (NSMM) is a rare plasma cell disorder that is often misdiagnosed. This case highlights the diagnostic challenges and successful VCD chemotherapy treatment in a patient with NSMM.
Area of Science:
- Hematology
- Oncology
- Rare Diseases
Background:
- Nonsecretory multiple myeloma (NSMM) is a rare subtype of multiple myeloma, accounting for 1-2% of cases.
- NSMM is characterized by clonal plasma cells that do not produce or secrete immunoglobulins.
- This rarity and unique characteristic contribute to diagnostic challenges.
Observation:
- A 71-year-old male presented with prolonged bone pain, initially misdiagnosed.
- Diagnostic workup revealed extensive bone destruction, monoclonal plasma cells (17.5% in bone marrow), and CKS1B gene amplification.
- Key diagnostic tests, including immunofixation electrophoresis, were negative, underscoring the nonsecretory nature.
Findings:
- The patient was diagnosed with Nonsecretory Multiple Myeloma (NSMM) based on clinical and pathological findings.
- Treatment with VCD chemotherapy (bortezomib, cyclophosphamide, dexamethasone) resulted in significant symptom relief (partial response) after two cycles.
- Flow cytometry confirmed the presence of monoclonal plasma cells, aiding in diagnosis.
Implications:
- This case underscores the importance of considering NSMM in patients with unexplained bone pain and myeloma symptoms, even with negative immunoglobulin tests.
- Early and accurate diagnosis is crucial for effective management of NSMM.
- VCD chemotherapy demonstrates efficacy in treating NSMM, warranting further investigation into long-term outcomes.
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