Q1. A 64-year-old man presents to his primary care physician for routine follow up. He has been feeling well and has no new complaints today. His medical issues include hypertension and diabetes. Complete physical examination is unremarkable. Laboratory testing shows elevated total protein, but the blood work including complete blood counts, serum calcium, serum creatinine and electrolytes are within normal limits. Subsequent evaluation reveals a 1.2 g/dL IgA monoclonal protein, with a serum free light chain (FLC) ratio of 1.4. Skeletal survey does not show any lytic bone lesions. Bone marrow biopsy shows 6% kappa clonal plasma cells. Which of the following is associated with increased risk of disease progression in this patient?
- (1) Age < 65 years
- (2) IgA subtype monoclonal protein
- (3) Abnormal FLC ratio of 1.4
- (4) Serum M protein level of 1.2 g/dL
- (5) Question not attempted