Objectives:

• Recognize various presentations for patients with monoclonal gammopathy
• Recognize monoclonal gammopathy of undetermined significance and appreciate its management
• Describe some complications related to monoclonal gammopathy

1		On a routine insurance physical, a 55-year-old man was found to have a total protein of 9 g/dl. The remainder of his serum chemistries and his CBC were normal. He is active, feels well, and is not taking any medications. His physical examination is unremarkable. You order a serum and urine electrophoresis with immunofixation and quantitative immunoglobulins. He has a monoclonal spike with 2,400 g/dl of IgG lambda (elevated). His other immunoglobulins are within normal limits. A skeletal survey demonstrates no lytic lesions, and his bone marrow aspirate and biopsy demonstrate 6% plasma cells (normal). After the bone marrow biopsy, the hematologist sends him back to you for follow-up. What is your next step in the management of this patient?
			A)	Monitor blood, including serum immunoglobulins, every 3-6 months and, if stable after 1 year, annually thereafter.
			B)	Monitor blood, including serum immunoglobulins, every 4 weeks.
			C)	Start on chemotherapy for multiple myeloma.
			D)	Obtain yearly bone marrow biopsy and skeletal survey.
			E)	No follow-up is necessary.