Table 4.

Clinical and laboratory findings that might herald malignant progression

Clinical signs/symptoms (unexplained)
 1. Anemia 
 2. Cardiomyopathy (restrictive) 
 3. Diarrhea 
 4. Fracture 
 5. Hepatomegaly 
 6. Hypercalcemia 
 7. Hyperviscosity (in the setting of IgM M-protein) 
 8. Intestinal pseudo-obstruction 
 9. Lytic lesion 
 10. Macroglossia 
 11. Nephrotic syndrome 
 12. Neuropathy (autonomic, sensory, or motor) 
 13. Purpura 
 14. Renal insufficiency 
Clinical signs/symptoms (unexplained)
 1. Anemia 
 2. Cardiomyopathy (restrictive) 
 3. Diarrhea 
 4. Fracture 
 5. Hepatomegaly 
 6. Hypercalcemia 
 7. Hyperviscosity (in the setting of IgM M-protein) 
 8. Intestinal pseudo-obstruction 
 9. Lytic lesion 
 10. Macroglossia 
 11. Nephrotic syndrome 
 12. Neuropathy (autonomic, sensory, or motor) 
 13. Purpura 
 14. Renal insufficiency 
Monoclonal protein studies
 1. Serum M-protein: IgG or IgA ≥3.0 g/dL 
 2. Urine M-protein ≥ 500 mg in 24 h 
 3. Serum κ or λ free light chain ≥100 mg/dL and involved/uninvolved FLC >100 
 4. 50% increase in serum monoclonal protein (absolute increase of ≥0.5 g/dL) 
Monoclonal protein studies
 1. Serum M-protein: IgG or IgA ≥3.0 g/dL 
 2. Urine M-protein ≥ 500 mg in 24 h 
 3. Serum κ or λ free light chain ≥100 mg/dL and involved/uninvolved FLC >100 
 4. 50% increase in serum monoclonal protein (absolute increase of ≥0.5 g/dL) 

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