The plasma cell dyscrasias: diverse presentations, pathophysiology, and management

The plasma cell dyscrasias have in common the proliferation of a single clone of plasma cells, but have disparate manifestations and natural histories. Multiple myeloma can present in protean ways, and early diagnosis is vital because timely supportive therapy and chemotherapy can give patients longer, better lives. Waldenström's macroglobulinemia may be manifested by the hyperviscosity syndrome, which responds to plasmapheresis. Patients with benign monoclonal gammopathy as strictly defined fare very well without therapy, but some asymptomatic patients with a serum monoclonal protein have incipient myeloma, so periodic reevaluation is essential.