Key Takeaways

  • Nonsecretory myeloma is a rare form of myeloma that is diagnosed through bone marrow biopsy and imaging tests rather than standard blood and urine tests, since cancer cells do not release detectable antibodies.
  • Treatment approaches for nonsecretory myeloma mirror those used for other myeloma types, including combination drug therapy with medications like proteasome inhibitors and immunomodulatory drugs, followed by stem cell transplantation.
  • Evidence suggests that people with nonsecretory myeloma may have the same, or possibly a better, outlook than those with other myeloma types.

Nonsecretory myeloma (NSMM) is a rare type of myeloma, which is a cancer of the plasma cells. In most cases, myeloma cells release (or secrete) antibodies into your blood and urine. But in NSMM, the cancer cells either do not make or do not release these antibodies.

Approximately 1% to 3% of all myeloma cases are NSMM. While this number was once thought to be higher, better testing has shown that in many people with myeloma, the cancer cells actually do make a small component of antibodies.

Although risk factors are not always clear, you may be more likely to develop multiple myeloma if you:

  • are over age 35 years, as less than 1% of cases are diagnosed before this age. The average diagnosis age is 70 years.
  • are Black
  • are assigned male at birth
  • have been exposed to radiation
  • have been exposed to specific chemicals, such as:
    • asbestos
    • pesticides
    • herbicides, like Agent Orange
    • chemicals used in rubber manufacturing

Symptoms of NSMM are similar to other types of myeloma and include:

If your doctor suspects you have any type of myeloma, they’ll take a history of your symptoms and when you first noticed them, as well as a family history. Then they’ll likely do a full physical exam and a range of blood tests.

Your doctor might do any or all of the following tests to confirm or rule out diagnosis:

  • Complete blood count
  • Creatinine levels, as a measure of kidney function
  • Albumin levels
  • Calcium levels
  • Immunoglobulin levels. Secretory myelomas affect immunoglobulin levels, so this helps identify the myeloma type. If the result is negative, it may indicate a NSMM.
  • Serum protein electrophoresis (SPEP). This test measures antibodies in your blood and can find monoclonal antibodies. A negative result may indicate NSMM.
  • Serum free light chains blood test, which looks only for a particular part of antibodies. If no immunoglobulins are found with SPEP, a negative test here as well can confirm an NSMM diagnosis.

Your doctor will also likely do a urine test to look for immunoglobulin. They will typically ask you to collect urine over 24 hours for a more accurate test.

If blood tests come back negative, your doctor may recommend a bone marrow biopsy. In this procedure, the doctor uses a needle to take a piece of your bone marrow. They then look at the cells in the marrow to see if they’re irregular. They can also examine genetic irregularities in cells, which may help predict disease outlook.

Finally, your doctor might recommend any of the following imaging tests to look more fully at your bones:

Treatment for NSMM is usually the same as for other myeloma subtypes. These treatments include:

Combination drug therapy

Depending on how advanced the NSMM is and how well your body tolerates the medications, people are usually given a combination of two or three medications, such as:

Stem cell transplant

Stem cell transplants are a common treatment for myeloma. They involve high dose chemotherapy to destroy bone marrow, then a transplant of healthy stem cells that will make healthy bone marrow cells. A stem cell transplant is often done after drug therapy.

People with myeloma usually get an “autologous stem cell transplant,“ meaning that their own healthy stem cells are taken and stored, then given back to them after they‘ve undergone treatment like radiation therapy. This helps the body recover from harsh cancer treatments.

Treatment for associated issues

NSMM can cause secondary health conditions, such as hypercalcemia. In most cases, you will also receive treatment for these conditions, which might include:

  • erythropoietin for anemia
  • bisphosphonates and corticosteroids for hypercalcemia
  • hydration for general health
  • antibiotics and antivirals to prevent infections

People with NSMM are often excluded from clinical trials because it’s a rare and atypical form of myeloma.

But finding other people with the condition can help you:

  • cope with your illness
  • navigate treatment and explore your options
  • deal with this major life change

To find a support group near you or virtually, ask your doctor or visit one of these sites:

We don’t know as much about NSMM survival rates as we do for other types of myeloma because it’s so rare. However, some older studies suggest the outlook is likely the same as, or even better than, other types of myeloma.

The survival rate of myeloma has been improving over the last several decades. Currently, the 5-year survival rates after diagnosis are:

  • 81% for localized myeloma
  • 62% for distant myelomas, also called multiple myeloma

The overall 5-year survival rate for myeloma is 62%.

NSMM is rare but very similar to other types of myeloma in terms of symptoms, diagnosis, and treatment.

Although not as much is known about NSMM compared with other types, some evidence suggests the outlook is better than in other types.

If you have any symptoms of myeloma, including bone pain, unexplained weight loss, and fatigue, see a doctor as soon as possible. If they suspect myeloma, they will likely do a range of tests. Even if initial blood tests are negative, imaging or biopsy may be required to diagnose NSMM.