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Multiple Myeloma — RACP Adult Medicine MCQ

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HardHaematologyMultiple MyelomaRACP Adult Medicine

A 60-year-old man presents with bone pain, fatigue, and recurrent infections. Investigations show: Hb 92 g/L, calcium 3.1 mmol/L, creatinine 210 µmol/L, total protein 105 g/L, and IgG kappa paraprotein 45 g/L. Skeletal survey shows lytic lesions in the skull and pelvis. What is the most important prognostic investigation?

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Correct answer: B — Cytogenetics by FISH

While all listed investigations are important in the workup of multiple myeloma, cytogenetics by FISH on bone marrow plasma cells is the single most important prognostic factor. High-risk cytogenetics include del(17p), t(4;14), and t(14;16), which significantly impact treatment decisions and survival. The Revised International Staging System (R-ISS) incorporates beta-2 microglobulin, albumin, LDH, and cytogenetics.

Reference: eTG – 2025 – Haematology; IMWG – 2022 – Myeloma Treatment Recommendations