title: Clinical Course and Prognosis of Non-Secretory Multiple Myeloma.
abstract: OBJECTIVE
  To determine the prognosis of patients with non-secretory myeloma. Methods: We studied 124 patients diagnosed with multiple myeloma who had no monoclonal protein detected on serum and urine immunofixation at diagnosis and on all subsequent follow up testing (non-secretory myeloma). The overall survival (OS) of patients with non-secretory myeloma was compared with 7075 patients with typical myeloma seen during the same time period in whom a monoclonal protein was detected at the time of diagnosis.
  
  
  RESULTS
  One hundred and twenty four patients met criteria for non-secretory multiple myeloma. The median follow-up was 102 months (range, 1-204 months). The median progression free survival with initial therapy was 28.6 months, and the median OS was 49.3 months. There was a significant improvement in OS since 2001; median survival 99.2 versus 43.8 months (prior to 2001) versus 99.2 months (2001-2012), P<0.001. OS was superior in patients with a normal baseline FLC ratio (n=10) compared to patients with an abnormal ratio (n=19), medians not reached in both groups. Prior to 2001, OS was similar in non-secretory myeloma (n=86) and secretory myeloma (n=4011), median 3.6 versus 3.5 years, respectively, P=0.63. However, among patients diagnosed between 2001-2012, OS was superior in non-secretory myeloma (n=36) compared to secretory myeloma (n=2942), median 8.3 versus 5.4 years, respectively, P=0.03.
  
  
  CONCLUSIONS
  Non-secretory myeloma is an uncommon subtype of multiple myeloma. In the last decade, there has been an improvement in the survival of non-secretory myeloma, and appears superior to secretory myeloma. This article is protected by copyright. All rights reserved.
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sagar S
authors.initials: SS
authors.lastname: Chawla
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Greenberg
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Larson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kyle
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar