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Smouldering Myeloma Risk — RACP Adult Medicine MCQ

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HardHaematologySmouldering Myeloma RiskRACP Adult Medicine

A 64-year-old has an IgG-kappa paraprotein of 18 g/L, marrow clonal plasma cells 8%, free-light-chain ratio 12, normal haemoglobin, calcium and renal function, and no focal lesion on whole-body imaging. How should this be classified?

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Correct answer: C — MGUS with risk factors requiring structured surveillance, not smouldering myeloma

Explanation lettering: C = shown as A · D = shown as C · E = shown as D · A = shown as E

D is correct because marrow plasma cells remain below 10%, M-protein is below 30 g/L, and there is no myeloma-defining event; the concentration and abnormal light-chain ratio increase progression risk and justify surveillance. E confuses a risk marker with the much higher myeloma-defining light-chain threshold and ignores marrow criteria. A invents a diagnostic cut-off. B requires a localised plasmacytoma. C ignores two recognised MGUS risk factors. The original item incorrectly labelled this profile smouldering myeloma.

Reference: Myeloma Australia, Myeloma and precursor conditions: https://myeloma.org.au/what-is-myeloma/