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Symptomatic multiple myeloma — RCPSC IM MCQ

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ModerateHematologySymptomatic multiple myelomaRCPSC IM

A 69-year-old man has back pain, fatigue and recurrent infections. Hemoglobin is 87 g/L, calcium is 2.94 mmol/L and creatinine is 188 micromol/L. Serum protein electrophoresis shows an IgG kappa M-protein and free light chain ratio is abnormal. Spine MRI shows multiple lytic lesions. What is the most appropriate investigation?

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Correct answer: A — Bone marrow biopsy with plasma cell assessment and cytogenetics

Suspected symptomatic multiple myeloma after monoclonal protein and CRAB features requires bone marrow confirmation and risk stratification.

Reference: Canadian Myeloma Research Group guidance