# Where are the immunoglobulins? A review of non-secretory multiple myeloma

## TL;DR

This paper reviews non-secretory multiple myeloma, a rare form of the disease where cancerous plasma cells do not produce detectable proteins, and discusses its diagnosis and treatment challenges.

## Contribution

The paper provides a comprehensive review of non-secretory multiple myeloma and highlights the importance of advanced diagnostics for better patient outcomes.

## Key findings

- Non-secretory MM accounts for 1–3% of all multiple myeloma cases.
- NSMM may have a less aggressive clinical course but shows conflicting literature results.
- Recent studies suggest NSMM may respond differently to therapy, requiring tailored approaches.

## Abstract

Multiple myeloma (MM) is a malignant neoplasm of clonal plasma cells, typically associated with the production of a monoclonal protein. In 1–3% of cases, MM presents without measurable monoclonal protein (M protein) in the serum or urine and normal serum-free light chains; these cases are referred to as non-secretory MM (NSMM). This definition has changed over time according to the sensitivity of laboratory methods for detecting paraproteins. NSMM has been previously reported to have a less aggressive presentation and clinical course compared to secretory MM; however, the literature is conflicting. Recent studies have indicated that NSMM may exhibit different responses to therapy and outcomes, emphasizing the need for a tailored approach. This review consolidates the current understanding of NSMM and underscores the importance of advanced diagnostic techniques in improving patient management and outcomes.