“Nonsecretory ” Multiple Myeloma

A case of “nonsecretory ” multiple studies failed to show production of myeloma with careful study of urine identifiable immunoglobulins. Bone and serum immunoglobulins is pre- marrow examination may be the only sented. Marrow immunofluorescent method of diagnosis in such cases. /[ULTIPLE MYELOMA PROTEIN STUDIES were pivotal in unraveling LII the mysteries of the immunoglobulins by allowing study of large quan-tities of a single, immunoglobulin molecule or a fragment thereof. The absence of any detectable abnormal protein in either serum or urine has been rarely well documented in multiple myeloma.’6 In these cases, as well as in the one reported here, bone marrow aspiration provided the diagnosis. CASE REPORT A 69-yr-old white woman became unable to walk due to severe back pain in July 1965. She had been well until the onset of back pain 2 mo earlier. Generalized bone tenderness was the only significant abnormality on physical examination. Bone x-rays showed wide-spread osteolytic lesions and osteoporosis. Aspirated bone marrow was heavily infiltrated by malignant-appearing plasma cells typical of multiple myeloma (Fig. 1). The following studies were either normal or negative: complete blood count, urinalysis, electrocardiogram, blood sugar, blood urea nitrogen, serum bibirubins, SCOT and SGPT, serum calcium, phosphorus, uric acid, alkaline phosphatase, sulfobromophthalein retention, lactic dehydro-genase, and x-rays of stomach, colon, and gall bladder. Cycbophosphamide, testosterone enanthate, and melpheian were used without apparent benefit during the 91/2 mo between diagnosis and death