Clinical and laboratory features

• Absence of symptoms or physical signs attributable to myeloma.

270 • Perform investigations listed for MM (fflp273).

• FBC: pre-transfusion haemoglobin >10g/dL.

• Serum chemistry: post-rehydration creatinine <130|_imol/L; normal serum Ca2+.

• |32-microglobulin: normal or minimally raised.

• BM aspirate: plasmacytosis >10% but normally <25%.

• BM cytogenetics: FISH identifies the abnormalities associated with MM; some patients have detectable chromosomal abnormalities by standard karyotype analysis.

• Skeletal radiology: should be normal.

• Other imaging: not yet routine; CT, MRI of spine FDG-PET and 99mTc-MIBI scan identify bone lesions in ~25% of patients with normal conventional radiology.

• BM plasma cell labelling index: (when measured) <1%.

• Stable paraprotein and other parameters on prolonged observation.

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