Beyond Negative Electrophoresis and Immunofixation: A Three-Case Series of Non-secretory Multiple Myeloma
Abstract
Non-secretory multiple myeloma is an uncommon plasma cell neoplasm in which serum and urine electrophoresis and immunofixation fail to identify a measurable monoclonal component. This phenotype may delay diagnosis and make conventional biochemical monitoring difficult. We report three cases of clinically non-secretory multiple myeloma presenting with anemia and multifocal skeletal involvement despite negative monoclonal protein studies. Case 1 was a 33-year-old man with progressive fatigue, normocytic anemia, normal renal function and calcium levels, negative serum and urine monoclonal studies, and a normal serum free light chain ratio. Bone marrow aspiration showed 19% plasma cells, whereas bone marrow biopsy demonstrated extensive CD138-positive plasma cell infiltration; 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed multifocal medullary lesions. Case 2 was a 63-year-old woman with low back pain and anemia, negative serum and urine immunofixation, and a normal serum free light chain ratio. Bone marrow aspiration showed 94% plasma cells, and 18F-FDG PET/CT demonstrated hypermetabolic skeletal lesions. She achieved partial remission after eight cycles of bortezomib, lenalidomide, and dexamethasone. Case 3 was a 68-year-old woman with fatigue, diffuse bone pain, anemia, negative serum and urine immunofixation, a normal serum free light chain ratio, 18% marrow plasma cells, and extensive PET/CT-positive skeletal disease. These…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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