Clinical characteristics and outcomes of oligosecretory and non-secretory multiple myeloma
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ORIGINAL ARTICLE
Clinical characteristics and outcomes of oligosecretory and non-secretory multiple myeloma Magdalini Migkou 1 & Irit Avivi 2 & Maria Gavriatopoulou 1 & Yael C. Cohen 2 & Despina Fotiou 1 & Nikolaos Kanellias 1 & Dimitrios Ziogas 1 & Evangelos Eleutherakis-Papaiakovou 1 & Evangelos Terpos 1 & Maria Roussou 1 & Efstathios Kastritis 1 & Meletios A. Dimopoulos 1 Received: 19 June 2019 / Accepted: 1 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Secretion of monoclonal immunoglobulins (MIg) detected in the serum and/or urine is one of the typical features of multiple myeloma (MM). However, some patients secrete MIg in quantities below “measurable” (termed oligosecretory MM) and others have no detectable MIgs by standard serum and urine immunofixation (termed non-secretory MM). In a cohort of 852 consecutive patients with active myeloma, we identified 100 (11.7%) patients with oligo/non-secretory MM, including 20 (2.3%) with non-secretory MM. Compared to patients with secretory MM, these were younger, less anemic, and had less often renal dysfunction and less extensive bone marrow infiltration. Presence and extent of bone disease were similar, however, hypercalcemia was less common and more often is ISS (International Staging System)-1 and, in those with available FISH (Fluoresense In Situ Hybridization) , high-risk cytogenetics were less common. FLCs (Free Light Chains) were available in 17 patients with nonsecretory MM: only 3 had normal FLC ratio; the others had abnormal ratio and 9/14 had involved FLC ≥ 100 mg/L. The 4-year OS for patients with oligo/non-secretory disease was 64% vs 58% for secretory MM. In multivariate analysis, oligo/nonsecretory disease was not an independent prognostic factor per se. Thus, 12% of MM patients present with oligo/nonsecretory disease at diagnosis and have different biologic characteristics but similar outcome to other MM patients. Keywords Immunoglobulins . Free light chains . Prognosis . Hypercalcemia
Introduction Multiple myeloma (MM) is characterized by the infiltration of the bone marrow by clonal plasma cells that secrete a monoclonal immunoglobulin (MIg) in the serum and/or urine. Typically, the amount of this MIg is large enough to be followed serially with relative accuracy and allow evaluation of the disease. The term “measurable disease” identifies such patients in which sufficient amount of MIg are detected at baseline. With the available conventional methods, “measurable
* Meletios A. Dimopoulos [email protected] 1
Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias 80, 11528 Athens, Greece
2
Hematology division, Tel Aviv Sourasky Medical Center, Sackler faculty of medicine, Tel Aviv University, 6 Weizmann Street, 6423906 Tel Aviv, Israel
disease” is defined as a serum M protein of at least 1 g/dl and a urine M-protein at least 200 mg/day, or both [1]. These thresholds were adapted considering that at lower levels standard electrophoretic assa
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