Management

The cornerstone of the management is regular follow up, so that any disease progression can be detected and appropriate therapy can be instituted. At the time of initial diagnosis, other plasma cell disorders should be ruled out, as mentioned before. Patients with small amounts of M-protein in their serum (< 0.5 g/dL) may not require a bone marrow examination or skeletal survey, given the low risk of progression seen in this group. However, the choice of tests should be dictated by the clinical assessment, and if suspicion is high, a complete workup, including bone marrow examination, skeletal survey, and urine protein electrophoresis, should be performed. The serum protein electrophoresis should be repeated at least annually to demonstrate stability of the M-protein. Patients with higher levels of M-protein, especially those with over 2 gm/dL, should have metastatic bone survey, quantitation of immunoglobu-lins, 24 hour urine examination for monoclonal protein, and a bone marrow aspirate and biopsy. A bone

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