Last reviewed: September 2018
Last updated: January  2018



History and exam

Key diagnostic factors

  • at-risk demographic (male, age >50 years, black ancestry)
  • clinically asymptomatic
  • positive family hx
  • hx of radiation or pesticide exposure

Other diagnostic factors

  • hx of immunosuppression or infections
  • presence of peripheral neuropathy

Risk factors

  • male gender
  • age >50 years
  • black ancestry
  • FHx of MGUS or multiple myeloma
  • immune-mediated conditions
  • radiation exposure
  • pesticide exposure

Diagnostic investigations

1st investigations to order

  • electrophoresis with immunofixation and measurement of serum immunoglobulins
  • CBC with differential
  • serum calcium
  • serum creatinine
  • urinalysis and 24-hour urine collection with electrophoresis and immunofixation
  • serum free light chains assay
  • metastatic bone survey (conventional x-ray or whole body low-dose CT scan)
Full details

Investigations to consider

  • bone marrow aspiration and/or biopsy
  • bone mineral density scan
  • MRI scan
  • PET scan
Full details

Treatment algorithm



Authors VIEW ALL

Professor of Medicine

Division of Hematology

Mayo Clinic




SK has served as a consultant for Janssen, Abbvie, Amgen, Merck, Celgene, Takeda, and Skyline.

Professor Shaji Kumar would like to gratefully acknowledge Dr Ola Landgren, a previous contributor to this topic. OL is an author of several references cited in this monograph.

Peer reviewers VIEW ALL

Consultant Haemato-Oncologist

Section of Haemato-Oncology

Brookes Lawley Institute of Cancer




DC declares that he has no competing interests.

Use of this content is subject to our disclaimer