A 54-year-old man is found to have an IgG kappa M-protein of 28 g/dL. Bone marrow shows 18% clonal plasma cells. Hemoglobin 12.8 g/dL, calcium 9.4 mg/dL, creatinine 1.0 mg/dL, normal skeletal survey, and serum free light chain ratio 1.4. He is asymptomatic. Next step in management?
- A Induction with bortezomib, lenalidomide and dexamethasone
- B Observation with reassessment every 3 to 6 months ✓
- C Zoledronic acid every 3 months
- D Autologous stem cell transplantation after induction
Correct answer: B. Observation with reassessment every 3 to 6 months
Explanation
This is smouldering multiple myeloma: M-protein below 30 g/L, marrow plasma cells 10 to 60 percent, and no CRAB features or SLiM myeloma-defining biomarkers (clonal plasma cells of 60 percent or more, free light chain ratio above 100 with involved chain above 100 mg/L, or more than one focal MRI lesion). Trials show no survival benefit from early therapy, so surveillance is standard; bisphosphonates are reserved for active bone disease.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.