Monitoring Non-Secretory Myeloma

Non-secretory multiple myeloma (NSMM) is a rare form of multiple myeloma in which standard blood and urine tests do not show the abnormal protein doctors usually track. Although this can make diagnosis and monitoring more complex, advances in imaging and bone marrow testing have greatly improved care. With the right tools and follow-up, people with NSMM can receive effective treatment and outcomes similar to other myeloma patients.

In this article, we’ll break down important updates that doctors and researchers are implementing to better monitor non-secretory patients and provide prompt treatment. 

What is non-secretory multiple myeloma?

Multiple myeloma is a blood cancer that begins in plasma cells, a type of white blood cell found in the bone marrow. In most people with myeloma, cancerous plasma cells produce an abnormal antibody called a monoclonal protein (M-protein) that is released into the blood or urine.

In non-secretory multiple myeloma, this protein cannot be detected using standard laboratory tests. This happens in about 1% to 5% of all myeloma cases.

Some people truly do not release protein at all, while others make very small amounts that stay inside the cancer cells or fall below detection limits. Understanding this difference is important because it affects how the disease is followed over time.

Non-secretory myeloma may be harder to detect with commonly used tests in myeloma

Most myeloma diagnoses rely heavily on blood or urine tests that detect M-protein.

People with NSMM often still develop classic myeloma-related problems, including:

• Bone pain or fractures
• Anemia (low red blood cells)
• Kidney problems
• High calcium levels
• Bone damage seen on imaging

Because lab tests may appear “normal,” diagnosis depends more on bone marrow examination and imaging studies.

How is non-secretory myeloma diagnosed?

Even without measurable M-protein, doctors use a combination of tests to confirm NSMM:

• Bone marrow biopsy to look for abnormal plasma cells. This is central to diagnosing NSMM.
• Immunohistochemistry (IHC), a special staining technique that highlights cancerous plasma cells, commonly uses CD138, which marks plasma cells, and kappa and lambda light chains, which indicate whether plasma cells are clonal (all derived from a single cancer cell). These techniques often reveal disease that routine testing misses, turning an “inconclusive” biopsy into a clear diagnosis .
• Advanced imaging, such as CT, MRI, or PET/CT scans, to detect bone and marrow involvement. Because NSMM cannot be followed with standard protein levels, imaging plays a much bigger role than in other forms of myeloma.
• Blood tests to evaluate anemia, kidney function, calcium levels, and beta-2 microglobulin (a marker of disease burden).

Living without a “number” to track

Many patients describe anxiety related to not having an M-protein level to follow. It can feel harder to know whether treatment is working or whether the disease is stable.

NSMM often requires:

• More frequent imaging
• Occasional repeat bone marrow biopsies
• Greater reliance on symptoms and physical findings

This can be physically and emotionally demanding, especially early after diagnosis.

Watch the free recording for our educational webinar How to Monitor Nonsecretory Myeloma, What Tests to Use, and How Often to learn more. 

Is treatment different for non-secretory myeloma?

The reassuring news is that treatment for NSMM is generally the same as for secretory myeloma. Patients respond well to modern therapies, including:

• Proteasome inhibitors
• Immunomodulatory drugs
• Steroids
• Stem cell transplantation, when appropriate

A diagnosis of non-secretory multiple myeloma can feel confusing and isolating, especially when tests don’t behave the way you expect. But NSMM is a recognized, treatable form of myeloma, and specialists now have strong tools to diagnose and monitor it effectively.

Can my myeloma type change to a non-secretory type? 

It is possible,  but it rarely happens. Sometimes, a secretory myeloma can evolve and become a nonsecretory patient. For some patients, after years of treatment, plasma cells lose the ability to produce the detectable protein, reflecting changes consistent with nonsecretory myeloma. 

With expert care, regular follow-up, and open communication with your healthcare team, NSMM can be effectively monitored and treated.

If you or a loved one has been diagnosed with non-secretory multiple myeloma, remember: the absence of a blood marker does not mean the absence of effective care. Advances in imaging, pathology, and treatment mean that doctors can see, measure, and treat this disease more clearly than ever before.

Stay tuned for more information and become a part of our community with the non-secretory chapter. 

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Keep reading more about non-secretory myeloma here.

Sources: 

• Non-secretory multiple myeloma: Diagnostic challenges and the value of imaging and immunohistochemistry
• Non-secretory multiple myeloma: Diagnosis and management
• Non-secretory myeloma: clinical profile and diagnostic utility of immunohistochemistry and free light chain assay in a rare variant of plasma cell myeloma